A 65-year old woman referred to me because of 2 day skin cha | Figure 1

BorisJ87

Infectious Diseases

A 65-year old woman referred to me because of 2 day skin change on the inner side of the left knee. She was working in the field, and after she came home she noticed redness and two punctiform lesions in the middle in mentioned area. During next day, the redness progressed, and she now feeling pain in the region with skin change. There is no fever other symptoms.

On exam, I noticed smaller livid redness in the middle, which is indurated and raised from surrounding skin with small pit in center, and bright redness around, which blanch with pressure. The whole area is warm on touch, and painful. There is no lymphadenopathy. The rest of exam is normal.

My thinking is that this is most likely some reaction to some insect bite. Infection is also a possibility. Despite its look, because of symptoms and quick progression of lesion, I would not consider erythema migrans.

What is your opinion?

P. S. The brown spot on the picture is some stain on my camera, not on the skin of the patient.

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