Giant Erythema in a Child with Lyme Disease

Nataliya Banadyha,1 Igor Rogalskyy,2 Roman Komorovsky3 1Department of Pediatrics, Faculty of Postgraduate Education, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine; 2Main Administration, State Service of Ukraine for Food Safety and Consumers Protection, Ternopil, Ukraine; 3Department of Internal Medicine II, Ivan Horbachevsky Ternopil National Medical University, Ternopil, UkraineCorrespondence: Roman Komorovsky, Email [email protected]: Herein we report a case of Lyme borreliosis in a pediatric patient, highlighting the diagnostic challenges associated with this condition. An 11-year-old girl was admitted with high fever, headaches, abdominal pain, and a progressing rash. Initial symptoms included small rashes that vanished with antihistamine treatment, but maculopapular rashes later emerged on the trunk and limbs, prompting further investigation. Differential diagnosis included toxic erythema, Stevens-Johnson syndrome, and Lyme borreliosis. Despite no reported tick bite and initial doubt due to the season, Lyme borreliosis was confirmed by serologic testing, diagnosing the patient with early disseminated Lyme disease. The diagnostic complexity was increased by the rash’s atypical presentation – large, homogeneous papular rashes. This case emphasizes the necessity for physicians to adeptly gather detailed histories and employ thorough, up-to-date diagnostic methods. Effective correlation of clinical findings with laboratory results and ongoing patient observation proved critical for an accurate diagnosis. This report underscores the importance of recognizing atypical presentations of Lyme borreliosis in children and the need for careful differential diagnosis.Plain language summary: We report the case of a 11-year-old girl diagnosed with Lyme disease, caused by tick bites that are often painless and hard to detect. This makes diagnosis challenging, especially in children. Her illness began with a small rash that disappeared with treatment. Over a few days, she developed a high fever, headaches, abdominal pain, and extensive rashes on her body.Initially, we considered other conditions like toxic erythema. However, new rashes kept appearing, prompting reconsideration. Despite no known tick bite, Lyme disease was suspected. A blood test confirmed Lyme disease, and she was treated with the antibiotic doxycycline. She improved significantly within 10 days, and no new rashes appeared after 2 weeks.This case highlights the need to consider Lyme disease even without a known tick bite. It underscores the importance of careful observation, detailed patient histories, and thorough testing to accurately diagnose and treat this disease in children.Keywords: erythema migrans, borreliosis, differential diagnosis, ticks