Lyme serology was positive for both IgG and IgM (ELISA, Enzygnost Borreliosis , Siemens, Dade Behring, Germany, and blot, Euroline WB , Euroimmun, Germany). A punch biopsy of a papule showed a dermal perifollicular ( fig. 2 ) – and occasionnally perineural – infiltrate of lymphocytes and plasma cells, consistent with a borrelial infection. Borrelia burgdorferi DNA was amplified from fresh tissu...