A few days after a summer hiking trip, a 25-year-old man comes to the clinic with a rash.On examination, the nurse notes that the rash consists of small, red, flat skin spots with a "bull's eye" pattern across his midriff and behind his knees.The nurse suspects:

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Lyme disease occurs in people who spend time outdoors in May through September.The first disease state exhibits the distinctive "bull's eye" and a red macular (small, flat skin spots) or papular (small solid bumps) rash that radiates from the site of the tick bite with some central clearing.The rash spreads 5 cm or larger and is usually in the axilla, midriff, inguinal area, or behind the knee, with regional lymphadenopathy.

A Few Days After a Summer Hiking Trip, a 25-Year-Old