ABSTRACT
Bambi comes into your GP office one morning complaining of a rash, lethargy and feeling like he has the flu. He recently lost his mother during a violent attack when she was shot and he has been to see you a few times with symptoms of low mood, for which he takes citalopram and is receiving cognitive behavioural therapy. He has no allergies and is otherwise fit and well. He reports having been on a stag do about a week ago in the New Forest. On the stag do, they went paintballing and he noticed he had a tick bite, which he removed. Despite removing this, he says the rash has spread. He does not have a fever currently and his observations are all within normal range. On examination he has a rash on his left thigh approximately 5.5 cm in diameter. There is an area of erythema at the site of the tick bite, surrounded by a paler area with a ring of erythema surrounding this that he says is spreading.
