case_images: PMC8150453_01
case_images: Skin lesion found over the right scapula.
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case_images: PMC8150453_01_10.1177_23247096211019558-fig1.jpg
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case_images: Furthermore, an isolated large 8 cm x 4 cm round targetoid skin lesion with central clearing was noted over the right scapula, which put Lyme disease higher on the differential (Figure 1).
case_images: Electromyography showed severe sensory neuropathy and diffuse demyelinating neuropathy in bilateral superficial peroneal nerves and sural nerves, with normal nerve conduction studies in upper extremities. Also note the skin temperatures in extremities, which may associate with autonomic vascular compromise despite use of an alpha-adrenergic agonist. F waves also show significant latencies in conduction, bilateral tibial nerves greater than peroneal nerves.
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case_images: fig2-23247096211019558
case_images: Electromyography done 1 month after admission was normal for muscles tested; however, nerve conduction studies showed severe sensory neuropathy and diffuse demyelinating neuropathy in bilateral lower extremities with normal nerve conduction studies in upper extremities (Figure 2).