Erythema Chronicum Migrans Afzelius in Americans

Erythema chronicum migrans Afzelius is frequently diagnosed in Northern European patients, but as Baer and Witten¹pointed 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