American traveler with Lyme disease

by Daniel J. Cameron, MD MPH

Doctors in Bogotá, Colombia, describe an encounter with a 24-year-old American woman whom they eventually diagnosed with Lyme disease seven days after she arrived in the country from Virginia, USA. [1]

The woman presented to a Bogotá emergency room with a “popular pruritic lesion in [the] right flank.” The patient told the ER physician that a week earlier, she had walked through the woods with her dog and had noticed a dark spot in the center of where a rash appeared. She was initially prescribed oral cephalexin for a presumed cellulitis. [1]

The next day, the hospital’s infectious disease department diagnosed Lyme disease based on her 27cm target-like rash, malaise, headache, arthralgia and abdominal pain, exposure history, and origin. Doxycycline was prescribed (100 mg/every 12 h) for a total of 10 days. The rash and symptoms resolved by the 7th day. [1]

The American woman was fortunate enough to present with a classic target-like erythema migrans rash. The challenge for doctors is to diagnose Lyme disease in travelers with atypical rashes, negative serologic testing, and late Lyme disease.

References:

1. Mantilla-Florez, Y.F., A.A. Faccini-Martinez, and C.E. Perez-Diaz, American woman with early Lyme borreliosis diagnosed in a Colombian hospital. Travel Med Infect Dis, 2017.