Ms. X, like a growing number of patients on the east coast, was diagnosed with Acrodermatitis Chronica Atrophicans (ACA), a late stage chronic Lyme disease manifestation caused by ongoing spirochetal infection. It is described in the literature as being associated with insidious multiple subjective and objective symptoms. Treatment guidelines state there are no prospective, randomized studies on treatment for ACA, however, antimicrobial treatment is recommended and prescribed for this chronic stage. Ms. X reports the antimicrobial therapy prescribed by my office has improved the condition, however, when therapy is discontinued her symptoms will return and progressively worsen. (See attached photos.)
Complications associated with the final stages of ACA, such as the difficult-to-treat ulcerations of the skin, which she is experiencing, give rise to ACA being an especially traumatic event for patients. Once at this stage, patient’s lives have often been compromised for years, and often damage has affected one or more organ systems that will not subside and is irreversible. The loss of hair and fragility of the skin associated with ACA leaves the patient poorly protected and vulnerable. Bacterial super-infections in patients have occurred. The physical, emotional and financial burdens incurred by the additional symptoms of Lyme-related ACA can be extensive. She has been experiencing increasing skin infections with ulceration.
Patients with chronic late-stage Lyme disease presenting with ACA manifestations like Ms. x can experience additional sacral pain, paresthesia, dysesthesia and cognitive dysfunction in conjunction with the visible skin manifestations. She has peripheral neuropathy, lymphadenopathy, musculoskeletal pains, and joint damage complicating her recovery. Destruction and deformity of the small joints of the hands and the feet is often seen along with, or independent of, additional complications and presentations, such as atrophy of the epidermis, morphea, lichen sclerosus atrophicus, facial edema, and paresis of the brachial plexus.
Fibrotic nodules may be seen on the surfaces of the elbows and knees. Edema with or without a bluish discoloration to the skin may occur, especially in the earlier stages. Scleroderma, venous insufficiency, Raynaud’s syndrome and an ongoing accelerated aging process are described in the literature as a possibility in patients with ACA. Ms. X has flare-ups of livedo associated with the ACA, a condition that is worse when she becomes cold or stressed. It can cause ulcers and pooling of blood and should be monitored. (See attached photos.)
Ms. X’s clinical picture, as mentioned above, was complicated by infection with other tick-borne organisms, and treatments for these were necessary for further improvement with her symptoms. She tested positive for Babesia microti on multiple occasions and more recently Babesia duncani. Both are infectious diseases, similar in some ways to malaria, and passed to humans by the bite of a tick. She also tested positive for several species of Bartonella (B. henselae, B. quintana, B. elizabethae), Ehrlichia, Anaplasma, Histoplasmosis, and Rocky Mountain Spotted Fever- all that have been detected in chronically ill Lyme disease patients in Maryland. Tests for tick borne diseases were performed at various labs for confirmation purposes. Opportunistic bacterial, parasitic and viral infections that can affect chronically ill Lyme patients, such as Parvo B-19, Epstein Barr Virus and Strep, are currently activated and contribute to her fatigue levels and additional symptoms, while adding strain to her weakened immune system in the process.