Spotting the target: clinical clues in the diagnosis of disseminated Lyme disease in pregnancy

Abstract

A 33-year-old G2P1 woman at 33 weeks’ gestation presented with 10 days of bifrontal headache despite treatment with sertraline, butalbital-acetaminophen-caffeine, and prochlorperazine and 2 days of pruritic body rash (Figure 1). Blood pressure and urine protein:creatinine ratio were within normal limits, but she had mild transaminitis. Her rash was originally thought to be caused by a drug-induced hypersensitivity reaction, however, in addition to a generalized morbilliform eruption, a physical examination revealed a large annular erythematous patch with a dusky center on the left popliteal fossa (Figure 2) and similar smaller annular lesions on the buttocks and legs (Figures 3 and 4).