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BACKGROUND Tick-borne diseases, including Lyme disease, are becoming increasingly common in Europe. Lyme disease has a wide variety of clinical manifestations, as a result of which physicians of diverse disciplines are coming into contact with such patients. CASE DESCRIPTION A 58-year-old man was seen at the emergency room with a symptomatic Wenckebach-type second-degree atrioventricular (AV) block and periods of 21 AV block. Four weeks previously the patient had noticed a red skin lesion on his left lower leg. Under the working diagnosi
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