Erythema Migrans

Synonyms: None.

Clinical Presentation (Fig. 4A):

■ Macules, patches, or plaques

■ Centrifugal extension with healing in the center leads to formation of annular shapes

■ Hemorrhagic or scaly lesions sometimes

Histopathology (Figs. 4B and C):

■ Perivascular and sometimes interstitial infiltrate of lymphocytes and plasma cells

■ Eosinophils in the vicinity of the "bite" of the tick in an early lesion

■ Spongiosis and parakeratosis rarely

Clinicopathologic Correlation:

Gougerot-Blum (lichenoid papules), lichen aureus (yellow or brown patches), purpura of Doucas and Kapetanakis (scaly papules), and purpura annularis telangiectodes of Majocchi (annular purpuric macules)

Histopathology (Figs. 5B-E):

■ Superficial perivascular and interstitial, sometimes lichenoid, infiltrate of lymphocytes

■ Dermoepidermal junction often spared but sometimes lymphocytes scattered in the epidermis accompanied by slight spongiosis and parakeratosis

■ Extravasated erythrocytes and/or siderophages in the upper part of the dermis

■ Wiry bundles of collagen in the upper part of the dermis, sometimes

Clinicopathologic Correlation:

Clinical Feature

Pathologic Feature

Annular plaque

Perivascular and sometimes

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