American traveler with Lyme disease
Travelers typically prepare to possibly incur infections when visiting other countries. A case study in Travel Medicine Infectious Diseases entitled “American woman with early Lyme borreliosis diagnosed in a Colombian hospital” reminds travelers that they should not overlook an infection they may have contracted from their country of origin. 
by Daniel J. Cameron, MD MPH
Doctors in Bogotá, Colombia, describe an encounter with a 24-year-old American woman whom they eventually diagnosed with Lyme disease seven days after she arrived in the country from Virginia, USA. 
The woman presented to a Bogotá emergency room with a “popular pruritic lesion in [the] right flank.” The patient told the ER physician that a week earlier, she had walked through the woods with her dog and had noticed a dark spot in the center of where a rash appeared. She was initially prescribed oral cephalexin for a presumed cellulitis. 
The next day, the hospital’s infectious disease department diagnosed Lyme disease based on her 27cm target-like rash, malaise, headache, arthralgia and abdominal pain, exposure history, and origin. Doxycycline was prescribed (100 mg/every 12 h) for a total of 10 days. The rash and symptoms resolved by the 7th day. 
The American woman was fortunate enough to present with a classic target-like erythema migrans rash. The challenge for doctors is to diagnose Lyme disease in travelers with atypical rashes, negative serologic testing, and late Lyme disease.
- Mantilla-Florez, Y.F., A.A. Faccini-Martinez, and C.E. Perez-Diaz, American woman with early Lyme borreliosis diagnosed in a Colombian hospital. Travel Med Infect Dis, 2017.