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We report a case of tick bite caused by Amblyomma testudinarium with a clinical feature of erythema migrans. e patient, a 60-year-old female, went hiking in the Rokko mountains in Hyogo prefecture on June 30. An erythematous macule with mild itching and a biting tick was found on the right side of her abdomen on July 2. On the rst visit (July 4), an annular erythema of 10 cm in size was recognized on the abdomen. She had no systemic symptoms and laboratory data were within normal limits. e tick was identi ed as a nymph of Amblyomma testudinarium. e skin rash was successfully treated with topical corticosteroids and had almost disappeared 2 weeks later without antibiotics. Serum antibody titers against Borrelia afzelii , B. burgdorferi, and B. garinii on the rst visit and 1 month later were negative. ese results indicate that the skin rash in this case, erythema migrans, was not associated with Lyme disease but an allergic reaction to salivary gland substances of the tick. Similarities between southern tick-associated rash illness and our case (tick-associated rash illness) are also discussed in this report.

Erythema migrans associated with Amblyomma testudinarium tick bite: Tick-associated rash illness