The most common clinical manifestation of Lyme disease is the characteristic 
rash, erythema migrans (EM). In the 1980s EM-like eruptions were reported in 
Missouri and other southeastern states. The EM-like eruptions, which were of 
unknown etiology, often followed the bite of the Lone Star tick (Amblyomma 
americanum) and the rash is called STARI (southern tick-associated rash 
illness). Although the Lone Star tick is found in the Lyme disease-endemic areas 
of New England and Mid-Atlantic regions of the United States, STARI has been 
reported only once from the Northeast and Mid-Atlantic regions. We report a 
child from Connecticut who visited Long Island, New York, and developed a rash 
that was thought to be EM. Because the patient failed to respond to antibiotics 
used to treat Lyme disease, an investigation ensued, and the diagnosis of STARI 
was established.