Tick bites in the Lyme light.

1Department of Paediatrics, Western University, London; 2Centre for Food Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario; 3National Microbiology Laboratory, National Public Health Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba; 4Departments of Paediatrics and Community Health and Epidemiology, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia; 5Centre for Food Environmental and Zoonotic Infectious Diseases; 6Laboratory for Foodborne Zoonoses, National Public Health Laboratories, Public Health Agency of Canada, Saint-Hyacinthe, Quebec Correspondence: Canadian Paediatric Surveillance Program, 2305 St Laurent Boulevard, Ottawa, Ontario K1G 4J8. Telephone 613-526-9397 ext 239, fax 613-526-3332, e-mail [email protected], website www.cpsp.cps.ca Accepted for publication April 8, 2015 A six-year-old boy presented to a walk-in clinic with a four-day history of an isolated, painless, nonpruritic, red rash with gradually expanding borders on his right arm. There was no history of fever, headache, myalgia, joint symptoms, palpitations, fainting or facial weakness. His family had returned two days previously from a three-week camping trip in the Point Pelee area of southern Ontario. During the trip, the patient had worn shorts and T-shirts most of the time, and rarely applied insect repellents. His examination was normal except the exanthem on his arm, which had a ‘bull’s eye’ appearance and measured 5 cm in diameter (Figure 1). He received a three-week course of amoxicillin and the rash was noted to gradually disappear over the period of therapy. Serological laboratory testing for Lyme disease was negative. He improved during follow-up, with resolution of the rash and no occurrence of neurological or musculoskeletal symptoms.