Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection

  • Author Footnotes
    a From the Department of Medicine, Northern Westchester Hospital Center
    ,
    Author Footnotes
    * In private practice.
    Kenneth B. Liegner
    Correspondence
    Reprint requests: Kenneth B. Liegner, MD, 8 Barnard Rd., Armonk, NY 10504.
    Footnotes
    a From the Department of Medicine, Northern Westchester Hospital Center
    * In private practice.
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  • Author Footnotes
    b From the Department of Dermatology, Northern Westchester Hospital Center
    ,
    Author Footnotes
    * In private practice.
    Judith R. Shapiro
    Footnotes
    b From the Department of Dermatology, Northern Westchester Hospital Center
    * In private practice.
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  • Author Footnotes
    c the Department of Dermatology, New York University School of Medicine
    David Ramsay
    Footnotes
    c the Department of Dermatology, New York University School of Medicine
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  • Author Footnotes
    d the Department of Dermatology, Albert Einstein College of Medicine
    Alan J. Halperin
    Footnotes
    d the Department of Dermatology, Albert Einstein College of Medicine
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  • Author Footnotes
    e the Microbiology Reference Laboratory.
    Wayne Hogrefe
    Footnotes
    e the Microbiology Reference Laboratory.
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  • Author Footnotes
    e the Microbiology Reference Laboratory.
    Lilly Kong
    Footnotes
    e the Microbiology Reference Laboratory.
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  • Author Footnotes
    a From the Department of Medicine, Northern Westchester Hospital Center
    b From the Department of Dermatology, Northern Westchester Hospital Center
    c the Department of Dermatology, New York University School of Medicine
    d the Department of Dermatology, Albert Einstein College of Medicine
    e the Microbiology Reference Laboratory.
    * In private practice.
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      Erythema migrans recurred in a patient 6 months after a course of treatment with minocycline for Lyme disease. Polymerase chain reaction on heparinized peripheral blood at that time demonstrated the presence of Borrelia burgdorferi-specific DNA. The patient was seronegative by Lyme enzyme-linked immunosorbent assay but showed suspicious bands on Western blot. Findings of a Warthin-Starry stain of a skin biopsy specimen of the eruption revealed a Borrelia-compatible structure. Reinfection was not believed to have occurred. Further treatment with minocycline led to resolution of the erythema migrans.
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