Multifocal erythema migrans – rare presentation in a 2-year-old child

Ticks are a vector of infectious diseases, both bacterial and viral. Among ticks, Lyme disease is considered to be the most common vector-borne disease in North America and Europe. Many countries in Europe are endemic for Lyme disease, especially the central and north-eastern regions. Lyme disease is characterized by numerous signs and symptoms from various organ systems including the skin, joints, heart and nervous systems. Early stage manifesting with skin symptoms occurs in most infected people. Erythema multiforme appears at the site of a tick bite usually within one month. Typical skin lesions enable the diagnosis based on the clinical picture without performing any additional tests. Diagnostic difficulties may be caused by less common atypical and multiple skin lesions, and if the patient has not noticed a tick bite. The case report concerns a child with erythema multiforme, and reviews the literature on erythema migrans and its atypical forms.