Abstract
<h3>To the Editor.—</h3> Lyme disease is a multisystem disorder caused by a tick-transmitted spirochete,<i>Borrelia burgdorferi</i>. In endemic areas, diagnosis is usually based on the presence of a characteristic skin eruption—erythema chronicum migrans. However, clinical presentations may vary and, thus, serological markers for<i>B burgdorferi</i>become important in confirming a diagnosis. In this report, we present a case of Lyme disease acquired in Tanzania. This case was remarkable for its atypical clin ical presentation, incomplete immune response, and occurrence in a nonendemic area. <h3>Report of a Case.—</h3> A 31-year-old white male Peace Corps volunteer returned from an extended tour of duty in Tanzania to Massachusetts and noted, during his return trip, the onset of an asymptomatic papular eruption on the left side of the chest at the site of known tick bites. The patient had incurred multiple tick and mosquito bites during his final weeks in Tanzania. These gradually expanded
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