Borrelial lymphocytoma
See Photos By Clicking Here
Ned Tijdschr Geneeskd. 2013;157(52):A6605.
[Borrelial lymphocytoma].
[Article in Dutch]
Schatorjé EJ, van der Steeg H, Stelma F, Hebeda K, Warris A.
Abstract
BACKGROUND:
Borrelial lymphocytoma is a relatively rare but typical presentation of Lyme disease. Predilection sites are the ears in children and chest/nipples in adults. It is treated like an erythema migrans and has a good prognosis.
CASE DESCRIPTION:
A 16-year-old boy presented with a swollen, red and painful right nipple since several months. An ultrasound showed normal breast tissue. The patient was referred to the pediatric surgeon who performed an incision biopsy. Histopathological examination revealed follicular hyperplasia without signs of malignancy. An infectious cause, most likely Lyme disease, was suspected. Serological analysis and PCR of the tissue confirmed the diagnosis of a borreliallymphocytoma, and the patient was treated with doxycycline with good result.
CONCLUSION:
Early recognition of the characteristic clinical presentation of borrelial lymphocytoma, supported by positive results from serologic testing for Lyme disease, avoids the need for additional and invasive diagnostic tests.
PMID: 24382037
http://www.ncbi.nlm.nih.gov/pubmed/24382037
***
Indian J Dermatol. 2013 May;58(3):167-74. doi: 10.4103/0019-5154.110822.
Lyme borreliosis and skin.
Abstract
Lyme disease is a multisystem illness which is caused by the strains of spirochete Borrelia burgdorferi sensu lato and transmitted by the tick, Ixodes. Though very commonly reported from the temperate regions of the world, the incidence has increased worldwide due to increasing travel and changing habitats of the vector. Few cases have been reported from the Indian subcontinent too. Skin manifestations are the earliest to occur, and diagnosing these lesions followed by appropriate treatment, can prevent complications of the disease, which are mainly neurological. The three main dermatological manifestations are erythema chronicum migrans, borrelial lymphocytoma and acrodermatitis chronica atrophicans. Many other dermatological conditions including morphea, lichen sclerosus and lately B cell lymphoma, have been attributed to the disease. Immunofluorescence and polymerase reaction tests have been developed to overcome the problems for diagnosis. Culture methods are also used for diagnosis. Treatment with Doxycycline is the mainstay of management, though prevention is of utmost importance. Vaccines against the condition are still not very successful. Hence, the importance of recognising the cutaneous manifestations early, to prevent systemic complications which can occur if left untreated, can be understood. This review highlights the cutaneous manifestations of Lyme borreliosis and its management.
KEYWORDS:
Borrelia, Doxycycline, Lyme disease, erythema chronicum migrans, ixodes
Full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667275/
***
Pediatrics. 2013 Jun;131(6):e1977-81. doi: 10.1542/peds.2012-1225. Epub 2013 May 13.
Lyme chondritis presenting as painless ear erythema.
Srinivasalu H, Brescia AC, Rose CD.
Abstract
Erythema of the ear lobe in the context of Lyme disease is caused by either borrelial lymphocytoma or localized erythema migrans. Here we present a case of chondritis limited to the ear cartilage caused by Lyme disease. The patient was treated with ceftriaxone with complete resolution of symptoms.
KEYWORDS:
ENT, Lyme disease, chondritis, otolaryngologic manifestations
PMID:
23669522
[PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms, Substances
http://www.ncbi.nlm.nih.gov/pubmed/23669522
***
Indian J Dermatol. 2012 Sep;57(5):387-9. doi: 10.4103/0019-5154.100496.
Red nodule on the breast.
Colucci R, Galeone M, Arunachalam M, Berti S, Pinzi C, Bellandi S, Moretti S.
Abstract
A 63-year-old woman living in the countryside referred to our department with a 2-month history of a red nodule localized on the right breast. Histological examination, immunohistochemical analyses and serologic evaluation conducted with ELISA and Western blot were performed. Clinical diagnosis of borrelial lymphocytoma was not possible solely on the clinical presentation of a classical nodular form without lymphoadenopathy. An absence of a referred prior tick bite and a previous or concomitant erythema migrans at clinical presentation rendered a more challenging diagnosis. The fact that the patient lived in the countryside, the appearance of the breast nodule in September, and serologic, histologic, and immunohistochemical analysis facilitated the diagnosis of borrelial lymphocytoma. We report this case to highlight the importance of an investigation of Lyme borreliosis when a patient living in the countryside presents with a red nodule of the nipple and areola.
KEYWORDS:
Borrelial lymphocytoma, breast, cutaneous nodule
PMID: 23112361
Free Full Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482804/
***
Ticks Tick Borne Dis. 2012 Sep;3(4):257-8. doi: 10.1016/j.ttbdis.2012.06.004. Epub 2012 Jul 27.
Borrelial lymphocytoma--a case report of a pregnant woman.
Moniuszko A, Czupryna P, Pancewicz S, Kondrusik M, Penza P, Zajkowska J.
Abstract
Borrelial lymphocytoma (BL) is a rare cutaneous manifestation of Lyme borreliosis. Epidemiological data show that BL is more common in children than in adults. It presents as a single bluish-red swelling located on the earlobe in children, near the nipple in adults. In our paper, we present a case of a pregnant woman with BL, which appeared after tick bite and disappeared completely after antibiotic therapy. The aim of the paper was to emphasize that in tick-borne disease endemic areas BL should be taken into consideration in cases of skin lesions.
Copyright © 2012 Elsevier GmbH. All rights reserved.
Link here: http://www.ncbi.nlm.nih.gov/pubmed/22906496
Hautarzt. 2012 May;63(5):381-9. doi: 10.1007/s00105-011-2256-0.
[The variable spectrum of cutaneous Lyme borreliosis. Diagnosis and therapy].
[Article in German]
Abstract
Lyme borreliosis can affect almost all human organs. Erythema migrans is the first and most frequent manifestation in 80-90% of patients in the early stage of localized skin infection. Besides the typical clinical appearance, many atypical variants can be observed. The solitary borrelial lymphocytoma is much less common and occurs mostly in children. Due to improvement in the early recognition of Lyme borreliosis, the diagnosis is made in the disseminated and late stage in only 10-20% of patients. Multiple erythemata migrantia indicating the hematogenous dissemination of B. burgdorferi remain frequently unrecognized. Late stages of infection feature chronic plasma-cell rich cutaneous inflammation and acrodermatitis chronica atrophicans in its edematous to atrophic forms. Cultivation or DNA detection of B. burgdorferi in skin biopsies are options to prove unusual skin manifestations. Serological detection of Borrelia-specific IgG- and IgM antibodies should be performed according to the two step protocol with ELISA and immunoassay according to the criteria of the MIQ 12. Serological tests have limited utility for follow-up. Antibiotic therapy is very effective if performed according to evidence-based protocols, such as the AWMF guidelines.
Infection. 2011 Feb;39(1):35-40. doi: 10.1007/s15010-010-0062-8. Epub 2010 Dec 10.
Isolation of Borrelia burgdorferi sensu lato from blood of adult patients with borreliallymphocytoma, Lyme neuroborreliosis, Lyme arthritis and acrodermatitis chronica atrophicans.
Maraspin V, Ogrinc K, Ružić-Sabljić E, Lotrič-Furlan S, Strle F.
Abstract
BACKGROUND:
Reports on patients with European Lyme borreliosis in whom borreliae were isolated from the blood are rare and nearly exclusively limited to those with solitary or multiple erythema migrans. Here we report on patients with other manifestations of Lyme borreliosis in whom borreliae were isolated from their blood.
PATIENTS AND METHODS:
This is a retrospective review of the medical files of patients diagnosed with borreliallymphocytoma, Lyme neuroborreliosis, Lyme arthritis and acrodermatitis chronica atrophicans at the Department of Infectious Diseases of the UMC Ljubljana, Slovenia, for whom a borrelia blood culture was ordered. The clinical features of patients whose blood culture tested positive for Borrelia burgdorferi sensu lato were reviewed, and the association between the proportion of patients with a positive blood culture and various clinical manifestations was examined.
RESULTS:
Borrelia burgdorferi sensu lato was isolated from the blood of 1/53 (1.9%) patients with borrelial lymphocytoma, 6/176 (3.4%) patients with Lyme neuroborreliosis, 1/13 (7.7%) patients with Lyme arthritis, and 3/200 (1.5%) patients with acrodermatitis chronica atrophicans. The time interval from the onset of symptoms attributed to Lyme borreliosis and the blood culture ranged from 1 day to >2 years (median 3.5 weeks). At the time of the blood culture, erythema migrans was present in 4/11 (36.4%) borrelia blood culture-positive patients, i.e. in the patient with borrelial lymphocytoma, the patient with Lyme arthritis and the 2/6 patients with Lyme neuroborreliosis. Only two of these 11 (18.2%) patients had fever at the time of the blood culture.
CONCLUSIONS:
In European patients with Lyme borreliosis, borreliae can be cultured from the blood not only early in the course of the disease but also occasionally later during disease progression.
Comment in
Borrelia burgdorferi bacteremia. [Infection. 2011]