Disseminated cutaneous EM lesions. A 57 year old man was seen by his primary care physician for fever, fatigue, headache, and arthralgia and no specific diagnosis was made. He presented for re-evaluation to one of the authors (JA) four days later, after his wife noticed a rash. On examination, he had multiple target lesions. Serology showed ELISA reactivity with positive confirmatory IgM and IgG western blots. Treatment with oral doxycycline resulted in a prompt response and resolution of the lesions and symptoms.