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Lyme disease is a process of unknown etiology that has been linked to bites of ticks of the Ixodes ricinus complex. Central Minnesota is an area of known Ixodes dammini distribution. This case represents the first recognition of
Lyme disease from this area. This case presented as a fluctuating meningoencephalitis with superimposed cranial neuropathy. The characteristic skin lesion, erythema chronicum migrans, was recognized by history, and oligoarticular arthritis subsequently developed. Physicians practicing in areas of known Ixodes tick distribution outside of the northeastern United States (coastal areas of Oregon and California, central Minnesota, northwestern Wisconsin, northwestern Utah, certain parts of ontario) should be alert to this
disease and aware fo the variety of symptom complexes that are possible with it.