INTRODUCTION
Lyme disease is a disease transmitted by the Ixodes scapularis tick, the majority of cases occur in the northeast region of the United States.1 There were over 250,000 cases between 2008-20192. The disease is caused by the spirochaeteBorrelia burgdorferi and other species of the same genus.3 Approximately 75% of cases of early Lyme disease are diagnosed at the emergency department or urgent care by identifying the characteristic skin findings of early Lyme disease, which necessitates no further serological testing.3
The characteristic rash of Lyme is erythema migrans (EM), a “bullseye” shaped area of redness with central clearing.3However, the appearance of the rash can differ, including the appearance of a necrotic center that mimics envenomation by the American brown recluse spider, Loxosceles reclusa .4 In this report, we describe an instance of Lyme disease masquerading as cellulitis which resulted in a diagnostic delay and complications that might have been prevented with earlier diagnosis. This is of particular importance during the COVID-19 pandemic, during which febrile illnesses can often lead to misdiagnoses.5 Verbal consent was obtained from the patient in preparation of this case report.