Large, patchy skin eruptions after a hiking trip

An Unusual Case of Bilaterally Symmetrical Neuropathic Osteoarthropathy of the Midfoot as a Result of Lyme Disease-Induced Peripheral Neuropathy: A Case Report

“…Lyme Disease is the most common vector-borne infection reported in the United States. 1,2,3 The disease is caused by the spirochete Borrelia Burgdorferi which is transmitted by the deer tick Ixodes scapularis (I. dammini) and Ixodes pacificus. 4,5 Thus, the presence of Lyme Disease correlates well with local deer populations.…”

“…4 Lyme Disease is manifested by a characteristic skin lesion referred to as erythema chronicum migrams (ECM) or “bull's-eye lesion” that develops within seven to 10 days after a bite from an infected tick. 1,4,5…”

“…8 Generally, Lyme Disease has been classified into three clinically overlapping stages. 1,2,5,6,8 In the first stage the characteristic ECM lesion appears. However, only about one-fourth of infected persons are diagnosed, as most are unaware they have been bitten.…”

“…6 This may be attributed to only one fourth of infected persons ever recalling being bitten in the first place. 1 A review of 200 consecutive patients by Berger, showed that 76% of lesions were seen on either the trunk or lower extremity. 2 In stage II the disease is manifested by neurological and/or cardiac abnormalities that may develop weeks to months after onset of the ECM lesion.…”

“…6 The neurological components of Lyme Disease can occur alone or in combination resulting in Bell's palsy, peripheral neuropathies (mononeuritis multiplex, radiculoneuritis, or diffuse peripheral neuropathy), radiculopathies, myelopathies, encephalitides, meningitides, Guillain-Barré-like demyelinating neuropathy, chorea, cerebellar ataxia, and pain syndromes. 1,2,5,6 Neurological abnormalities often present as a characteristic triad of cranial nerve palsies, meningitis, and peripheral radiculoneu-ropathy. 5 Some reports have indicated that if left untreated, neurological manifestations of Lyme Disease will develop in 15% to 20% of those infected.…”