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Clinical Report

The Many Faces of Solitary and Multiple Erythema Migrans

doi: 10.2340/00015555-1549


Case definitions for European Lyme disease have been published. However, multiple erythema migrans may pose a diagnostic challenge. Therefore, we retrospectively reviewed the clinical and serological findings and response to therapy in a cohort of consecutive 54 patients with PCR-confirmed erythema migrans, referred to a university dermatology clinic. The proportion of patients with multiple erythema migrans lesions (usually 2 or 3) was almost equal (46%) to the proportion of patients with single erythema migrans lesions (54%). All patients, except for 2 multiple erythema migrans patients with a concomitant autoimmune disease, completely responded to treatment. In conclusion, multiple erythema migrans may be more common than anticipated, and since only 50% of the patients were seropositive when seeking medi-cal help, PCR testing of skin lesions is helpful to confirm the diagnosis in clinically atypical cases.


Pernilla Eriksson, Marika T. Schröder, Kirsi Niiranen, Antti Nevanlinna, Jaana Panelius, Annamari Ranki
Department of Dermatology and Allergology, Helsinki University Central Hospital, FIN-00029 HUS, Finland. E-mail:


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Volume 93, Issue 6

DOI: 10.2340/00015555-1549

Pages: 693-700

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