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Hi, plz help me. Do you have any idea what the diagnosis
is for this case?

young man, Hx of recent trip to Minnesota, multiple erythema
migrans, eschar was found on skin examination...

Lyme dz can develop multiple EM but it does not make
an eschar? Any thoughts?

Lyme dz originally doesn't have eschar, no sure..

Maybe anthrax?

ricketsial infection tooo

Anthrax has eschar!

so does boutoneuse which is ricketsial

if i remember correctly, the choices were:

1) borrelia burgdorferi
2) brucella
3) francisella tularensis
4) leptospira
5) rickettsia

The only condition associated with erythema migrans is Lyme disease.
It is pathognomonic. The diagnosis of Lyme disease is established clinically without the need of lab tests if this kind of rash is seen.