Block Island, New York
The patient is a 3-year-old girl who was seen for evaluation of a solitary lesion on the midback that has been present for about four days. At the onset, she had a high fever, 105-106 F. She was seen in the ER and referred to her pediatrician. A diagnosis of Lyme disease was made and the patient was started on amoxicillin. Blood studies were drawn. Over the next two days, the fever persisted and then disappeared two days ago. The child has a good appetite, sleeping well, playing normally. Her parents feel she is "grumpy." She says the area on her back hurts.
|At onset with fever|
|Four days later|
Comment: In the initial photo taken by the patient's mother, the lesion looks to be ~ 5 cm or larger. This would suggest Lyme disease. High fever is unusual with Lyme disease so the question of co-infection with Ehrlichiosis or Babesiosis needs to be considered. Amoxicillin is not effective for those disorders, but many cases resolve spontaneously. For the time being, it might be best to observe this child. Serologies for the latter two diagnoses could be drawn if they were not looked for initially.