Disseminated Erythema Migrans

A 66- year old lady, with comorbidities of hypertension, hyperlipidemia, and obesity presented to the emergency department with fever and malaise of two weeks duration. Four weeks before the presentation she reported having a tick bite on her right groin. A few days later she noticed a bull’s eye lesion over the same area which she ignored. Within the next two weeks, she developed high grade, intermittent fever, malaise, and fatigability. She also developed multiple, painless, red color skin lesions involving her arms, legs and lower back.