1: Classic erythema migrans (EM) rash | Initial presentation of EM. A photo used by multiple organisations, so GPs likely to be familiar with. Then patient revealed to have been bitten by a tick |
2: Borrelial lymphocytoma | Borrelial lymphocytoma of the ear lobe |
3: Acrodermatitis chronica atrophicans (ACA) | With associated peripheral neuropathy |
4: Bell’s palsy | Later revealed to have insect bite on scalp |
5: Recurrent synovitis of knees | None |
6: Multiple EM rashes | Patient had been walking in Dartmoor |
7: Heart rhythm abnormalities | None |
8: Fatigue, post-exertional malaise, anxiety, headaches, and memory issues | Later patient reveals an international lab report saying she has Lyme disease, and she demands long-term antibiotics |
9: Fatigue, arthralgia, poor ability to concentrate, myalgia, mood swings | None |
10: Non-engorged tick attached to scalp | None |
11: Poor fine motor movements, rash 2 months previously at scout camp. This had been treated with erythromycin. | None |