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How the incidence of an EM rash can be inflated
The incidence of an erythema migrans (EM) rash, a definitive sign of Lyme disease, has been touted by Shapiro and Wormser as occurring in at least 90% of patients. Their claim is published in a recent letter to the editor in JAMA. [1] So, how did they reach this conclusion? The answer lies in the two studies they cite. [2,3]