Case Report

Southern Tick-Associated Rash Illness: Erythema Migrans Is Not Always Lyme Disease

Authors: Lucas Blanton, MD, Brad Keith, MD, Walter Brzezinski, MD

Abstract

Southern tick-associated rash illness (STARI) is a rash occurring after a tick bite. It is a form of erythema migrans, an annular rash with central clearing that is almost identical with the erythema migrans seen in Lyme disease. The etiologic agent is not known but may be a Borrelia species. The tick vector is different in the two diseases. Serious systemic complications are not currently recognized with STARI but treatment with doxycycline is prudent. Differentiating STARI from Lyme disease is discussed.


Key Points


* Southern tick-associated rash illness (STARI) has a rash that is indistinguishable from that of Lyme disease.


* No serious systemic complications from STARI are currently recognized.


* In the Southeast, STARI is much more prevalent than Lyme disease.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Fitzpatrick T, Johnson R, Klaus W. Color Atlas and Synopsis of Clinical Dermatology. New York: McGraw-Hill, 2001:672–683.
 
2.Masters E, Granter S, Duray P, et al. Physician-diagnosed erythema migrans and erythema migrans-like rashes following lone star tick bites. Arch Dermatol 1998;134:955–960.
 
3.Wormser GP, Masters E, Nowakowski J, et al. Prospective clinical evaluation of patients from Missouri and New York with erythema migrans-like skin lesions. Clin Infect Dis 2005;41:958–965.
 
4.James AM, Liveris D, Wormser GP, et al. Borrelia lonestari infection after a bite by an Amblyomma americanum tick. J Infect Dis 2001;183:1810–1814.
 
5.Varela AS, Luttrell MP, Howerth EW, et al. First culture isolation of Borrelia lonestari, putative agent of southern tick-associated rash illness. J Clin Microbiol 2004;42:1163–1169.
 
6.Wormser G, Masters E, Liveris D, et al. Microbiologic evaluation of patients from Missouri with erythema migrans. Clin Infect Dis 2005;40:423–428.
 
7.Oliver JH Jr, Chandler FW Jr, Luttrell MP, et al. Isolation and transmission of the Lyme disease spirochete from the southeastern United States. Proc Natl Acad Sci USA 1993;90:7371–7375.