Diffuse fasciitis (DF) [diffuse fasciitis with eosinophilia-Shulman's syndrome] has occasionally been linked to a precedent infection with Borrelia burgdorferi. Here, we report on another case of DF in a 25 year old male, in whom Borrelia burgdorferi infection as possible inciting agent could be identified based on the patient's history and laboratory data. Efforts to microscopically demonstrate spirochetes or to amplify Borrelia-DNA by nested PCR in lesional tissue failed after antibiotic treatment had already been initiated. Although only a few cases of Borrelia associated diffuse fasciitis have been reported in the literature, the link between typical signs and symptoms as well as laboratory findings of Borrelia infection and the onset of diffuse fasciitis, starting at the primary site of EM, provide indirect evidence for a causative role of Borrelia burgdorferi as a potential infectious agent for DF.