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A 42-year-old man was referred for a febrile (38.23C) eruption. Lesions consisted of maculopapules, with a vesiculous centre, sometimes slightly in®ltrated. They were symmetrically distributed on the lower and upper limbs and featured an atypical target appearance on the palms (Fig. 1). The trunk and mucous membranes were unaffected. Histological examination of a palmar lesion showed marked dermal oedema and lymphohistiocytic in®ltration around small dermal vessels. The general examination was normal. There was no history of recurrent herpes infection and no drug intake in the previous 4 weeks. However, the patient reported a probable tick bite on the right ankle 2 weeks before admission, which was followed 4 days later by a round and rapidly extensive erythematous plaque, 15 cm in diameter, which disappeared spontaneously within 8 days. Routine blood tests were unremarkable. Serological tests were negative for Herpes simplex virus, Mycoplasma, Chlamydia, Rickettsia conori, Coxiella burneti, Treponema and Leptospira. The Borrelia burgdorferi titre was elevated with 3 methods: 1/25,600 with haemagglutination test (normalv1/200), 1/512 (normalv1/256) with indirect immuno ̄uorescence test and 0.582 (normalv0.160) with an immunoenzymatic test. The patient was treated with 3 g/day amoxycillin for 3 weeks and the skin lesions disappeared within 10 days. Another Borrelia serology test remained positive at the end of treatment (1/128,000 with haemagglutination test, 0.43 with immunoenzymatic test).

Atypical Erythema Multiforme Occurring at the Early Phase of Lyme Disease?