Erythema chronicum migrans of Lyme disease
B. W. Berger
Erythema chronicum migrans (ECM) is the distinctive cutaneous lesion of the
multisystem tick-borne spirochetosis, Lyme disease. Its clinical and
histologic pictures are variable. Of the 51 patients with ECM of Lyme
disease, 38 patients (75%) had single lesions, 13 patients (25%) had
multiple lesions, and 32 patients (62%) had extracutaneous signs and
symptoms. Only 15 patients (29%) had symptoms referable to ECM.
Extracutaneous signs and symptoms were absent in 12 (80%) of the 15
patients. These patients had uneventful recoveries following treatment with
systemic antibiotics. Thirty-four skin biopsy specimens were obtained from
the ECM lesions of 30 patients. With Warthin-Starry silver stain, the
Ixodes dammini spirochete was found in 14 specimens (41%) taken from 12
(40%) of the 30 patients. Two of the Ixodes dammini spirochete-positive
specimens were obtained from secondary ECM lesions. Careful clinical and
histologic examination of skin lesions suggestive of ECM of Lyme disease
will expedite its early diagnosis and treatment.
