The administration of 1% framycetin sulfate tulle in combination with 1% silver sulfadiazine cream in one case of suspected Lyme disease: a case report

Background: Lyme disease is a zoonotic infection transmitted by ticks, caused by Borrelia burgdorferi sensu lato complex. Although cases are considered rare, the disease is likely under-reported in Southeast Asia. The initial cutaneous manifestation typically appears as erythema migrans with a characteristic “bull’s eye” appearance; however, atypical forms may also occur. Diagnosis is generally established through clinical evaluation supported by a history of tick exposure. Management includes systemic antibiotic therapy along with appropriate wound care. To date, only limited studies have reported Lyme disease cases in Indonesia, underscoring the need for increased diagnostic awareness and appropriate therapeutic strategies. Case Presentation: A 48-year-old woman presented with a blister on her left anterior thigh accompanied by pain, following a tick bite that occurred four days before admission. The blister progressively enlarged, ruptured, and formed crusted lesions. Dermatological examination revealed a solitary, discrete, oval erythematous macule measuring 16×14 cm with a “bull’s eye” appearance, surrounded by a wall of bullae and blackish-red crusts. The patient was treated with oral clindamycin 300 mg three times daily for ten days, along with topical application of 1% framycetin sulfate tulle combined with 1% silver sulfadiazine cream. Conclusion: This case highlights a suspected Lyme disease in a 48-year-old woman, successfully managed with systemic antibiotic therapy and combined topical wound dressing. After six months of follow-up, the lesion resolved completely without complications, highlighting the importance of clinical recognition and early treatment, particularly in regions where Lyme disease is not frequently reported.