Case report: Early Lyme disease: Solving the subtle clinical clues in an elderly patient

Document Type


Publication Date

April 2007


This article has been peer reviewed. It was published in Clinical Geriatrics 15(4):20-23, April 2007, and is freely available from the publisher's website at http://www.clinicalgeriatrics.com/article/7054#.


CASE PRESENTATION A 63-year-old woman presented in June complaining of a 1-week history of malaise, headache, generalized body aches, and low-grade fever of 101 degrees F. She denied any upper respiratory, gastrointestinal, or other associated symptoms. Physical examination was generally unremarkable with the exception of a slightly raised, 8 x 6–cm, irregular, ovoid patch with spotty areas of mildly intense-to-faded erythema found on her right anterior thigh (Figure 1). A central papule was noted, consistent with a punctum from a recent tick or insect bite (Figure 2). When the lesion was pointed out to the patient, she remembered that it had been present for several days. She described the skin lesion as mildly pruritic, slightly tender, and slowly expanding. On further questioning, the patient recalled removing a small insect from her leg—possibly a tick—the week before while gardening. Her house borders a large city park in Pennsylvania, and deer sightings are frequent.

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