Erythema migrans disease. A contribution to its clinical features and relation to Lyme disease

: A largely prospective study averaging 33 months was undertaken in 30 patients with and one without (chronic) erythema migrans. In one case erythema migrans disappeared spontaneously, in the 29 others it persisted up to six months, but quickly responded to antibiotic treatment. Measured from the tick bite in 9 patients or from onset of the erythema migrans, arthritis and arthralgia appeared in ten patients on average 6.5 months (0.7-36), and persisted for eight months (0.2-42). In seven of these patients sensory disturbances appeared three weeks (1-10) later and (or) signs of meningitis which lasted for four months (0.5-16), while in three patients cardiac symptoms appeared a few weeks later, persisting for 4.5 months (0.3-12). In one patient tracheolaryngitis developed two months later, persisting for three months. These manifestations occurred in seven patients despite antibiotic treatment. Extradermal manifestations in two patients were successfully treated with high parenteral penicillin doses, in one instance followed by tetracyclin. "Erythema migrans disease", differing from Lyme disease described in the U.S.A. in only a few aspects, apparently cannot be successfully treated with low oral doses of penicillin, but can in certain circumstances be favourably influenced by high parenteral doses of penicillin G.