Tick-borne lymphadenopathy – rickettsial skin infection with local lymphadenopathy and systemic symptoms following a tick bite

Introduction
In face of recently increasing incidence rate, tick-borne diseases have gained importance in the field of public health. Lyme disease – the most common disease in Europe associated with bites by these arthropods – is not the only disease transmitted by ticks. Its differential diagnosis should include, inter alia, rickettsiosis. It is estimated that up to 40% of Dermacentor ticks in Poland have a positive polymerase chain reaction test result for the presence of rickettsial DNA.

Objective
We present a case of a man with rickettsial skin infection with local lymphadenopathy and systemic symptoms following a tick bite.

Case report
A 53-year-old man was admitted to the Department of Dermatology because of a skin lesion located in the area of the left lower abdomen (at the site of a tick bite) and enlargement of inguinal lymph nodes on the left side. Twenty four days before hospitalization in the Department of Dermatology, the patient was bitten by a tick, which he removed himself. On admission the clinical examination revealed a 1 cm ulcer covered with a black crust. Surrounded by erythematous papules with scaling and peripheral post-inflammatory discoloration. In addition, an approx. 6 cm pack of swollen, tender, hard, inguinal lymph nodes that could be freely moved was present on the left side.

Conclusions
The presented case shows that in Poland, in patients with a history of a tick bite, the differential diagnosis should also take into consideration tick-borne diseases other than Lyme disease or tick-borne encephalitis.