Could she have Lyme disease?

A nine-year-old girl has been bitten while on holiday

Audrey, a previously well nine-year-old girl, presents to her local emergency department with sudden-onset unilateral facial weakness.


One month earlier, she had been bitten on the neck by a tick while in France. 

The next day, Audrey developed flu-like symptoms, which rapidly resolved over 24 hours.

Ten days later, a rash developed at the site of the tick bite.

The rash was macular, erythematous and pruritic, with 2-3 small vesicles, but no eschar. She was treated by her GP with 10 days of oral sulfamethoxazole and trimethoprim,