PMC7658693_01
Right Lower 1 Extremity Dermatomal Rash.
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Scale score of 14 due to confused responses to questions), dysarthric speech, fresh abrasions to his bilateral knees, and scabbed-over cutaneous lesions along the L5 dermatome of the right lower extremity (Fig. 1). Social history was significant for long days spent working outdoors, including exposure to heavily wooded areas, frequent mosquito bites, a tick bite 3 months ago, exposure to dogs and goats, and no recent travel.
MRI Brain.
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MRI of the brain demonstrated abnormal signal of the bilateral medial frontal cortices, left insula, medial temporal lobe, amygdala, and hippocampus, and also found abnormal enhancement of lepto- and pachymeninges (Fig. 2).