Lyme Disease in a Traveler: Diagnosis in an American Patient Abroad
Lyme disease can present in travelers outside endemic regions, creating diagnostic challenges for clinicians unfamiliar with the condition. A case from Colombia highlights the importance of recognizing exposure history in patients presenting abroad.
This raises an important question: how often is Lyme disease missed or delayed in travelers? Diagnosis may depend on recognizing clinical features and travel history, even in regions where Lyme disease is uncommon.
Doctors in Bogotá, Colombia, reported a case of a 24-year-old American woman who was diagnosed with Lyme disease seven days after arriving from Virginia, USA.
Initial Presentation and Misdiagnosis
The patient presented to an emergency department with a pruritic lesion on her right flank. She reported walking in wooded areas with her dog one week earlier and noticing a dark spot at the center of a rash.
She was initially treated with oral cephalexin for presumed cellulitis.
Recognition of Lyme Disease
The following day, the infectious disease team diagnosed Lyme disease based on a 27 cm target-like erythema migrans rash, along with malaise, headache, arthralgia, abdominal pain, and exposure history.
Doxycycline (100 mg twice daily) was prescribed for 10 days. Her rash and symptoms resolved within 7 days.
Clinical Implications for Travelers
This case highlights the importance of considering Lyme disease in patients traveling from endemic areas, even when they present in regions where Lyme disease is not commonly diagnosed.
Recognition is more straightforward when a classic erythema migrans rash is present. However, diagnosis may be more difficult in patients with atypical rashes, negative early serologic testing, or later-stage disease.
Patients may benefit from review of Lyme disease symptoms, understanding testing limitations, and awareness of coinfections when symptoms are unclear.
References
- Mantilla-Florez YF, Faccini-Martinez AA, Perez-Diaz CE. American woman with early Lyme borreliosis diagnosed in a Colombian hospital. Travel Med Infect Dis. 2017.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
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