Lyme disease (borreliosis) is a multi-systemic spirochetal infection, primarily caused by Borrelia burgdorferi, which is transmitted by Ixodes (Ixodid) species of ticks. Although it is the most common arthropod-borne disease in the U.S. and Europe, there have been relatively fewer reports of clinical cases in Korea. During the early disseminated stage, secondary erythema migrans may occur at sites distant from the site of tick attachment, signaling hematogenous dissemination of B. burgdorferi. We report a case of a 22-year-old woman who presented with unusual primary erythema migrans and multiple secondary erythema migrans. Despite lack of typicality of the clinical features, serologic investigations including immunofluorescent assay and Western immunoblot against specific antigens revealed Lyme disease.
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