Lyme disease mimics cellulitis skin infection

patient with lyme disease being examined for cellulitis

Lyme disease can mimic acute and chronic illness. In their article “Lyme Disease Mimics Postoperative Cellulitis,” the authors describe a patient who developed an abdominal rash, which was initially diagnosed as cellulitis, six days after a laparoscopic left salpingo-oophorectomy surgery. [1]

The 40-year-old woman, who developed redness, swelling, pain, and a rash at the excision site, was treated with cephalexin and later switched to trimethoprim/sulfamethoxazole (TMP/SMX).  This case describes a case where Lyme disease mimics cellulitis.

“Over the next 24 hours, there was a rapid expansion of abdominal redness and patchy areas of redness on her left groin and her right forearm,” the authors write. The patient had complained of muscle and joint stiffness but attributed it to recent outdoor camping and exercise.

The woman was “admitted for postoperative cellulitis remote from surgery.” She was treated with doxycycline for possible Lyme disease, due to her recent camping trip and exposure to ticks.

Within hours of starting doxycycline, the patient’s “abdominal erythema [rash] significantly receded, the forearm and leg rashes resolved, and the joint pain and stiffness improved markedly.”

The Lyme disease diagnosis was confirmed with an IgM Western blot test.

“Initial suppression of the worsening rash could have been due to a low level of TMP/SMX activity on Borrelia burgdorferi stationary phase cells,” the authors explain.

[bctt tweet=”Rashes caused by Lyme disease may be incorrectly identified and attributed to other conditions, such as cellulitis.” username=”DrDanielCameron”]

The woman’s IgG Western blot test was negative.

Although Lyme disease can present with erythema migran rashes, early rashes can be confused with cellulitis. The authors suggest, “Lyme disease should be considered in patients with cellulitis in areas of endemic Lyme.”

Lyme disease rashes have been misidentified

Lyme disease rashes were misidentified in a case series involving 88 patients who presented with an erythema migrans (EM).  In 13 of these patients, the rash had been incorrectly identified or treated.

“Rashes were often misidentified by clinicians and patients as a spider bite, cellulitis, or shingles,” wrote Aucott and colleagues. [2]

The authors concluded, “Until more accurate tests are developed for early Lyme disease, cases without a diagnostic EM rash will need to be managed carefully.

In patients with cutaneous lesions where the differential diagnosis of cellulitis is not certain, empiric antibiotics should be chosen that will have activity against both Lyme disease and common agents of cellulitis.”

Editor’s note: I have prescribed cefuroxime or amoxicillin/clavulanic acid if Lyme disease is a consideration. Neither cephalexin nor TMP/SMX are effective against Lyme disease. If I believe Lyme disease is involved, I will treat patients longer than 7 to 10 days.  You can look at the rash yourself as the journal is open access.

  1. Miles S, Mansuria S. Lyme Disease Mimics Postoperative Cellulitis. J Minim Invasive Gynecol. Nov 15 2020;doi:10.1016/j.jmig.2020.11.002
  2. Aucott J, Morrison C, Munoz B, Rowe PC, Schwarzwalder A, West SK. Diagnostic challenges of early Lyme disease: lessons from a community case series. BMC Infect Dis. Jun 1 2009;9:79. doi:10.1186/1471-2334-9-79

2 Replies to "Lyme disease mimics cellulitis skin infection"

  • Sharon Rich
    01/06/2024 (10:33 am)

    I had a terrible case of cellulitis in my wrist, for several months. , Antibiotics and steroids helped ease the pain some but for the most part I suffered. I had the heat, swelling shoot pain and stabbing pain. I was helpless.
    Seven months out my fingers on that hand stay swollen and I am unable to use my hand and still have some pain in my wrist. Last month I was diagnosed with Lyme disease. Prior to all this I worked 10 hour days using impact tool building box truck bodies. I’m a sixty year old female. I haven’t work in almost a year because of this. I have pain in my shoulders my back and neck. I’m trying to fight this. No more funds to go back to doctor. Trying herbs for what that’s worth…

  • Donna in AZ
    04/16/2021 (2:38 am)

    This is very interesting, I too had a bite and went to the doctor they said it was shingles or cellulitis, both medications for these did not clear the issue, I went to ER because of concern of cellulitis not clearing up and the ER did see a red circle area and referred me to a dermatologist, she too saw the red circle area and I had been to Traverse City MI for a family vacation and it is a hot spot for Lyme, I had to beg her to keep me on doxycycline for two months, it cleared up the redness, but the pain and shooting pain my my leg continued for awhile but two plus years later I still suffer from swelling in my leg and ankle on the side I was bitten, horrible brain fog. I had the flu like symptom about 5 days later coming back from my trip and then right after that the redness on the back of my leg, horrible debilitating fatigue/exhaustion and other symptoms followed, got tested it came back negative but I know it was Lyme , I had all the symptoms and they treat you like you are making it all up and it is not uncommon for tests to come back negative. I am confused why I would make something up like this, I still get random deep nerve pain in the area that I was bitten. I live in AZ and no one here really is familiar with lyme disease. Luckily where I work my boss knew of a friend who had lyme so he was sympathetic to my issues. Terrified of Covid and just as terrified as getting a vaccine when I obviously have some active issues ongoing.

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