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 is red, macular, with a bull's eye pattern across his midriff and behind his knees. What does the nurse suspect?

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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 or papular 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, or behind the knee, with regional lymphadenopathy. Rubeola presents as a red-purple maculopapular blotchy rash that first appears behind the ears and then spreads over the face followed by the neck, trunk, arms and legs. Eczema, or atopic dermatitis, is a chronic inflammatory skin lesion that presents as erythematous papules and vesicles with weeping, oozing, flaking, fissures, crusts, and severe pruritis. An allergic drug allergy often presents with a generalized erythematous and symmetric rash.

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