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What is This Eschar on the Right Calf?

What is This Eschar on the Right Calf?

Case Report

A 58-year-old male dermatologist was on a flight home to New York after a trip to Sardinia, Italy, when he began to develop chills. The following day, he experienced fevers up to 103 °F, drenching sweats, and uncontrollable rigors. His wife, whom he traveled with, had a confirmed streptococcal pharyngitis infection, so he decided to start himself on amoxicillin 500 mg three times per day. However, he continued to have high fevers and chills. Three days after his flight home, he noticed a faint, erythematous, macular rash on his torso and noted a tick embedded in the skin of his right calf (Figure 1). The tick was removed, and at the site of the tick bite the following morning, a 6-mm eschar (Figure 2) had developed. He decided to discontinue the amoxicillin and started himself on doxycycline 100 mg twice per day. After the third dose of doxycycline 5 days after onset, his symptoms began to dramatically improve.

Image of brown dog tick (Rhipicephalus sanguineus)6-mm ulcerated lesion with central necrosis located on the right calf

What Is The Diagnosis?

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