PMC5927188_01
Skin erythema migrans seen in the present patient (The photo was kindly provided by the patient).
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She also noted temporary characteristic skin changes with slight itching and pain on her right limb about 1 week after camping, which might be so-called erythema migrans (Figure 1).
Anti-Borrelia antibodies detected by recomLine Borrelia IgG and IgM strip immunoassays (Mikrogen Diagnostik, Neuried, Germany). Sera 2055 and 2056 were collected in July and August 2017, respectively. The patient's sera reacted to various recombinant antigens as follows; p100 (93 kDa antigen), VlsE, p41 (41 kDa antigen, Flagellin), p39 (BmpA), OspCs (21-24 kDa antigen), and p18 (18 kDa antigen). The test result suggested the patient was serologically IgM and IgG positive for Lyme disease (https://www.mikrogen.de/uploads/tx_oemikrogentables/dokumente/GARLBB007EN.pdf). The patient also tested IgM positive for Lyme disease by the Center for Disease Control and Prevention recommendations.. Note: Recommended reading: Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR. 1995;44(31):590-591.. Abbreviations: IgG, immunoglobulin G; IgM, immunoglobulin M.
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The patient's symptoms, including fatigue, mouth sagging, and hardly closed eye, subsequently improved, and serum testing was positive for anti-Borrelia antibodies (Figure 2).