Erythema chronicum migrans Afzelius in Sweden. A study on 231 patients

In order to describe the clinical manifestations of erythema chronicum migrans Afzelius (ECMA) in Sweden and to compare them with those in Lyme disease in the United States, 231 patients with ECMA were investigated. Although there are many similarities between the two disorders the findings also point to differences. The skin lesions were of longer duration (median 5-6 weeks) than those in Lyme disease but less often multiple (8%). General symptoms were found in about half of the patients with a short disease duration (less than or equal to 3 weeks), but were usually mild. Laboratory abnormalities were noted in only a minority of the cases. At the time of diagnosis none of the patients had spirochete-induced arthritis, but in three of them cardiac involvement was suspected. Among 16 untreated patients meningitis later developed in two patients and arthritis in one. Diagnostic procedures such as serologic testing and cultivation of spirochetes are discussed.