Interesting Rash

I was working yesterday in Fast Track when a younger male came in with a rash almost identical to the one above.  I found this picture on google so I included it here (I’m still trying to work out the kinks of posting patient photos on the blog.)  As most of you can guess, this is a pretty classic erythema migrans rash seen in patients with Lyme Disease.  I was pretty surprised because I haven’t seen this since I left North Carolina where I did my residency.  It turns out this guy was a forester and had been hiking in Ohio and Pennsylvania.  He believes however that this tick was from his Ohio hike.  This illustrates that while it is rarely seen in Ohio, it happens, so we need to be on the lookout!