Expanding the clinicopathological spectrum of late cutaneous Lyme borreliosis (acrodermatitis chronica atrophicans [ACA]): A prospective study of 20 culture- and/or polymerase chain reaction (PCR)-documented cases - 18/04/17
Abstract |
Background |
The diagnosis of acrodermatitis chronica atrophicans (ACA), the late cutaneous manifestation of Lyme borreliosis, can be challenging. Histologic changes in ACA have been described in a few studies from endemic countries, relying on cases documented by serology only.
Objectives |
We sought to reassess the clinicopathological spectrum of ACA in a series of thoroughly documented cases.
Methods |
Patients prospectively included in a national prospective study were selected on the basis of positive culture and/or polymerase chain reaction of a skin biopsy sample. The diagnosis of ACA was confirmed by reviewing the clinical and serologic data. Histopathological samples were carefully reviewed.
Results |
Twenty patients were included. Unusual clinical features (ie, numerous small violaceous patches and equidistant small spinous papules with background faint erythema) were observed in 2 patients. Histopathological examination revealed a classic plasma cell–rich perivascular and interstitial pattern with telangiectases in 16 of 25 samples, whereas strikingly prominent granuloma annulare–like or lichenoid features were observed in 4 and 2 of 25 cases, respectively, and discrete nonspecific minor changes in 3 of 25 cases.
Limitations |
The small number of patients was a limitation.
Conclusions |
Genuine culture- and/or polymerase chain reaction–proven ACA can rarely present as numerous violaceous patches or cluster of spinous papules clinically, and as a granuloma annulare–like or lichenoid dermatosis histologically.
Le texte complet de cet article est disponible en PDF.Key words : acrodermatitis chronica atrophicans, Borrelia burgdorferi, borreliosis, granuloma annulare, lichenoid dermatitis, plasma cells
Abbreviations used : ACA, GA, PCR
Plan
Drs Lenormand, Jaulhac, and Lipsker are members of the French study group of Lyme borreliosis (GEBLY: groupe d’étude de la borréliose de Lyme). |
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Supported by a Société Française de Dermatologie grant. |
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Conflicts of interest: None declared. |
Vol 74 - N° 4
P. 685-692 - avril 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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