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The authors present an unusual case of lobular panniculitis caused by Borrelia burgdorferi senso latu infection in a 56-year-old man. It presented clinically as a solitary subcutaneous nodule. Histopathologically, the lesion resembled subcutaneous panniculitis-like T-cell lymphoma by manifesting atypically appearing lymphocytes with cytotoxic phenotype. B. burgdorferi etiology was proven by positive polymerase chain reaction and serology and positive response to antibiotics.

Erythema nodosum is an inflammatory reaction of the skin characterized by tender erythematous patches or nodules, usually located on the lower extremities. This report illustrates an association of erythema nodosum with a rare malignancy and an uncommon infectious agent in humans. There are many diseases associated with erythema nodosum; we propose that hairy cell leukemia and group C streptococcus be considered among this list.