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Lyme borreliosis, a multisystem illness caused by a tick-borne spirochete Borrelia burgdorferi, can affect the skin, joints, central and peripheral nervous systems, and heart. In 1922 Garcin and Bujadoux reported radiculopathy following a tick bite and a skin lesion called erythema chronicum migrans.1 Some authors estimate that as many as 40% of patients with late Lyme borreliosis present with peripheral nervous system abnormalities.2
Case report.
A 64-year-old woman from Louisiana presented with severe neck and upper back pain. Three months earlier she had been on an autumn foliage tour in the northeastern United States, visiting Vermont, Connecticut, Maine, and Massachusetts. A week following, she developed severe sinus-like frontal headaches but no fever, chills, cough, or flu-like illness. She was treated for sinusitis with azithromycin, without headache improvement. She then developed a nonpruritic erythematous papular rash on her forearm that gradually enlarged but without any central clearing and without improvement …
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