https://www.ncbi.nlm.nih.gov/pubmed/29731651

Infect Drug Resist. 2018 Apr 26;11:625-628. doi: 10.2147/IDR.S162048. eCollection 2018.

A case of Lyme disease in a Japanese woman.

Seki M1, Watanabe Y2, Kawabata H3.

Abstract
This report presents the case of a Japanese patient who developed Lyme disease. The patient was a 44-year-old woman who had general fatigue and the inability to open her mouth. She was initially suspected of having mild tetanus with lockjaw; however, she reported a past history of a tick bite while camping in the USA and had erythema migrans 2 months before this visit. Finally, Lyme disease was serologically confirmed. A few cases of Lyme disease are annually reported in Japan; however, this infectious disease should also be suspected.

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**Comment**

Kudos to the researchers for refraining from stating that her inability to open her mouth is an atypical presentation or rare.  Nothing about this rat snarl is rare anymore.

 Just look around.