Erythema Chronicum Migrans Afzelius in Americans

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Abstract
Erythema chronicum migrans Afzelius is frequently diagnosed in Northern European patients, but as Baer and Witten1 pointed out recently, is seldom seen in Americans. The purpose of this paper is to report a case seen at the USAF Hospital Wiesbaden (Germany) in an American stationed in Europe. Erythema chronicum migrans Afzelius is a curious and rather infrequently seen disease in which a tick bite is followed by the appearance of a small ring of persistent, slightly elevated erythema. Over a period of months the ring enlarges peripherally, clearing centrally, until it may attain a diameter of several feet. Since the ring conforms to the shape of the area of the body affected, the lesion can produce a bizarre appearance. It is usually asymptomatic, although some itching or burning may be experienced by the patient. Double rings have been reported; however, this was not seen in our patients. The cause

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