https://www.ncbi.nlm.nih.gov/pubmed/30013872

Cureus. 2018 May 10;10(5):e2608. doi: 10.7759/cureus.2608.

The Emergence of a Forgotten Entity: Dermatomyositis-like Presentation of Lyme Disease in Rural Wisconsin.

Novitch M1, Wahab A2, Kakarala R3, Mukerji R4.

Abstract
Dermatomyositis (DM) is one of the rare clinical manifestations of tickborne-related autoimmune presentations; we report an uncommon case of Borrelia-related DM-like presentation from rural Wisconsin. A 76-year-old female presented with fatigue, malaise, weight loss and progressive proximal muscle weakness after a flare-up of shoulder arthritis. She had a heliotrope rash (reddish, purplish rash on or around eye-lids) and a Shawl sign (pigmented skin resembling a shawl on the upper back, shoulders and neck) in addition to generalized cutaneous (skin) erythema (redness) with edema (swelling).

There was no history of tick bite, Lyme disease (LD) or DM.

The physical exam revealed erythema migrans (EM) and DM-like musculocutaneous findings. Enzyme-linked immunosorbent assay and western blot were positive for LD.

The patient received intravenous ceftriaxone and doxycycline for five days, leading to the resolution of EM lesions and improvement in her muscle weakness. In addition, DM-like features resolved with antiborrelial treatment and required no steroids or immunosuppressants.

Workup including electromyography, skin or muscle biopsy could not be performed as the patient improved clinically. At six months post-treatment, she remained in remission.

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**Comment**

This lady needs long-term follow up.  Five days of antimicrobials is loose change.

Again, nothing about Lyme is rare.  We are in the dark as to prevalence as nobody’s keeping track.  Just because it isn’t in the literature doesn’t mean it doesn’t happen.  At this point there is such a polarization and denial that most practitioners will look for anything but Lyme.  It’s been like this for over 40 years.  It’s hardly made the literature.

https://www.healthline.com/health/dermatomyositis  Dermatomyositis is a rare inflammatory disease. Common symptoms of dermatomyositis include a distinctive skin rash, muscle weakness, and inflammatory myopathy, or inflamed muscles

In this case it is caused by borrelia, the causative agent of Lyme Disease.