Tick-borne rash at the surgical site prior to lung cancer resection: a diagnostic and surgical dilemma case report.

Background: Managing emerging infectious exposures in the context of urgent surgical intervention, where standard guidelines may not provide direct answer, can be challenging. Case Description: We present a unique case involving a 69-year-old female patient undergoing video-assisted thoracic surgery (VATS) for biopsy-confirmed adenocarcinoma of the right lower lobe (RLL). During preoperative preparation, a live Ixodes tick was found embedded in the patient's right flank, directly over the intended surgical site, accompanied by a large erythematous rash suggestive of erythema migrans. Despite the patient being asymptomatic of Lyme disease, this finding posed an important question of whether to delay a time-sensitive surgery or proceed through a potentially infected field. The tick was resected fully intact and sent to the path lab for analysis. In adherence with Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA) guidelines, and after infectious disease consultation, the surgical team proceeded with the surgery. The surgery and recovery proceeded uneventfully. Conclusions: This case illustrates a rare intersection of vector-borne illness and thoracic oncologic surgery. It demonstrates that timely surgery can safely proceed, in the appropriate context, after complete tick excision. The case also underscores the importance of preoperative skin examination in endemic regions and the need for clinical guidelines when unexpected, rare infections occur at surgical sites.