Clinical practice. Lyme disease

N Engl J Med. 2014 May 1;370(18):1724-31. doi: 10.1056/NEJMcp1314325.

Abstract

A 32-year-old pregnant woman from southeastern Connecticut presents to her physician in July at 26 weeks' gestation because of a skin lesion. She reports she has had fatigue, arthralgia, and headache for 2 days and a rash in her left axilla for 1 day. She lives in a wooded area and works in her garden frequently. Six weeks earlier, she had removed a small tick that was attached behind her right knee. On physical examination, she is afebrile. She has an erythematous, oval macular lesion, 7 to 8 cm in diameter, in her left axilla, with enhanced central erythema; no other abnormalities are noted. How should her case be managed?

Publication types

  • Review

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Antibodies, Bacterial / blood*
  • Borrelia burgdorferi / immunology
  • Borrelia burgdorferi / isolation & purification*
  • Doxycycline / therapeutic use*
  • Erythema Chronicum Migrans / diagnosis*
  • Erythema Chronicum Migrans / drug therapy*
  • False Negative Reactions
  • Female
  • Humans
  • Lyme Disease / immunology
  • Lyme Disease / prevention & control
  • Lyme Disease / transmission
  • Practice Guidelines as Topic
  • Pregnancy

Substances

  • Anti-Bacterial Agents
  • Antibodies, Bacterial
  • Doxycycline