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STARI: When Should it be Suspected?

A 48-year-old Caucasian male was working in South Carolina as a home inspector. He had not traveled recently, but he reported a tick bite about six weeks before presentation to his physician. The tick was firmly attached to the skin. He later noticed an expanding red ring from the site of the tick bite. He was diagnosed as having erythema migrans and treated with doxycycline 100 mg b.i.d. (two times a day) for 14 days. Lyme disease titers at the time of diagnosis and following treatment with antibiotics were negative and the rash resolved after two months.

A diagnosis of STARI must be made on the basis of clinical evidence. STARI is suspected when these three facts are true:
  • The patient is seronegative with tests for Lyme disease
  • The patient has an erythema migrans lesion
  • The patient was bitten by a tick in the Southern United States