Typical disseminated EM lesions with VII nerve palsy. An 18 year old man was seen for new VII nerve palsy. A complete physical exam showed multiple lesions consistent with disseminated cutaneous Lyme disease. Serology for Lyme disease showed ELISA and IgM reactivity. Treatment with oral doxycycline resulted in a prompt resolution of the rash, with recovery of the VII nerve palsy over the next several weeks.