Multifocal erythema migrans - rare presentation in a 2-year-old child

Area of Science:

• Medical Entomology
• Infectious Diseases
• Dermatology

Background:

• Ticks transmit various bacterial and viral infections.
• Lyme disease is a prevalent tick-borne illness in North America and Europe.
• Central and northeastern Europe are particularly endemic for Lyme disease.

Observation:

• Lyme disease manifests with diverse symptoms affecting skin, joints, heart, and nervous systems.
• Early-stage Lyme disease commonly involves skin manifestations, such as erythema multiforme at the tick bite site.
• Diagnosis is often clinical, but atypical or multiple lesions, or unnoticed bites, can complicate identification.

Findings:

• Erythema multiforme is a common early skin symptom of Lyme disease.
• Typical erythema multiforme lesions facilitate clinical diagnosis.
• Atypical erythema migrans and unobserved tick bites present diagnostic challenges.

Implications:

• Recognizing typical and atypical erythema multiforme is crucial for timely Lyme disease diagnosis.
• Understanding varied skin presentations aids in managing this common tick-borne disease.
• This case report and literature review highlight diagnostic considerations for Lyme disease presentations.