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The patient is a 29-year-old white male who presented three weeks after returning from a camping trip, during which he removed three ticks from his chest and back after being bitten.

He reports a one-week history of fever, fatigue, hot and cold spells, and arthralgia, and a one-day history of popular rash on the dorsum of his feet (Figure 1 and Figure 2).

Figure 1.

Figure 2.


Clinical Challenge: March, 2009
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