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Two Unusual Cases of Diffuse Acrodermatitis Chronica Atrophicans Seronegative for Lyme Borreliosis

  • T. G. Berger
  • C. Schoerner
  • H. Schell
  • M. SimonJr
  • G. Schuler
  • M. Röllinghoff
  • A. GessnerEmail author
Brief Report

Acrodermatitis chronica atrophicans (ACA) is a late cutaneous manifestation of Lyme borreliosis [1]. In this stage of disease, serum IgG-antibodies against Borrelia burgdorferi have been detected in practically all patients examined so far [2, 3, 4]. Reported here are the cases of two patients with unusual manifestations of ACA. The histopathological pattern was consistent with ACA in both cases, but repeated serological examinations for antibodies against Borrelia burgdorferi were negative. The diagnosis was only confirmed in both cases by the detection of Borrelia burgdorferi-specific DNA using nested PCR and subsequent sequencing of the products.

ACA occurs in Europe in up to 10% of patients with untreated infection with Borrelia spp. [5], but it is rarely found in the USA [6]. Currently under discussion is whether the causative Borrelia subtype is exclusively Borrelia afzelii or possibly other species such as Borrelia burgdorferi sensu stricto or Borrelia garinii. Molecular...

Keywords

Lyme Disease Borrelia Burgdorferi Lyme Borreliosis Venous Insufficiency Chronic Venous Insufficiency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgement

This work was supported by the IZKF grant A2.

References

  1. 1.
    Asbrink E, Hovmark A, Hederstedt B (1984) The spirochetal etiology of acrodermatitis chronica atrophicans Herxheimer. Acta Derm Venereol 64:506–512PubMedGoogle Scholar
  2. 2.
    Plorer A, Sepp N, Schmutzhard E, Krabichler S, Trobos S, Schauer G (1993) Effects of adequate versus inadequate treatment of cutaneous manifestations of Lyme borreliosis on the incidence of late complications and late serologic status. J Invest Dermatol 100:103–109PubMedGoogle Scholar
  3. 3.
    Koning J de, Tazelaar DJ, Hoogkamp-Korstanje JA, Elema JD (1995) Acrodermatitis chronica atrophicans: a light and electron microscopic study. J Cutan Pathol 22:23–32PubMedGoogle Scholar
  4. 4.
    Asbrink E (1985) Erythema chronicum migrans Afzelius and acrodermatitis chronica atrophicans. Early and late manifestations of Ixodes ricinus-borne Borrelia spirochetes. Acta Derm Venereol 18 (Suppl 1):1–63Google Scholar
  5. 5.
    Asbrink E, Hovmark A, Olsson I (1986) Clinical manifestations of acrodermatitis chronica atrophicans in 50 Swedish patients. Zentralbl Bakteriol Mikrobiol Hyg 263:253–261Google Scholar
  6. 6.
    Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ (1987) Lyme disease in Europe and North America. Lancet 1:681Google Scholar
  7. 7.
    Ryffel K, Peter O, Rutti B, Suard A, Dayer E (1999) Scored antibody reactivity determined by immunoblotting shows an association between clinical manifestations and presence of Borrelia burgdorferi sensu stricto, B. garinii, B. afzelii, and B. valaisiana in humans. J Clin Microbiol 37:4086–4092PubMedGoogle Scholar
  8. 8.
    Wienecke R, Zochling N, Neubert U, Schlupen EM, Meurer M, Volkenandt M (1994) Molecular subtyping of Borrelia burgdorferi in erythema migrans and acrodermatitis chronica atrophicans. J Invest Dermatol 103:19–22PubMedGoogle Scholar
  9. 9.
    Asbrink E, Brehmer-Andersson E, Hovmark A (1986) Acrodermatitis chronica atrophicans—a spirochetosis. Clinical and histopathological picture based on 32 patients; course and relationship to erythema chronicum migrans Afzelius. Am J Dermatopathol 8:209–219PubMedGoogle Scholar
  10. 10.
    Robertson J, Guy E, Andrews N, Wilske B, Anda P, Granstrom MA (2000) European multicenter study of immunoblotting in serodiagnosis of lyme borreliosis. J Clin Microbiol 38:2097–2102PubMedGoogle Scholar
  11. 11.
    Huppertz HI, Schmidt H, Karch H (1993) Detection of Borrelia burgdorferi by nested polymerase chain reaction in cerebrospinal fluid and urine of children with neuroborreliosis. Eur J Pediatr 152:414–417PubMedGoogle Scholar
  12. 12.
    Marconi RT, Garon CF (1992) Development of polymerase chain reaction primer sets for diagnosis of Lyme disease and for species-specific identification of Lyme disease isolates by 16S rRNA signature nucleotide analysis. J Clin Microbiol 30:2830–2834PubMedGoogle Scholar
  13. 13.
    Asbrink E, Hovmark A, Hederstedt B (1985) Serologic studies of erythema chronicum migrans Afzelius and acrodermatitis chronica atrophicans with indirect immunofluorescence and enzyme-linked immunosorbent assays. Acta Derm Venereol 65:509–514PubMedGoogle Scholar
  14. 14.
    Luft BJ, Dattwyler RJ, Johnson RC, Luger SW, Bosler EM, Rahn DW (1996) Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial. Ann Intern Med 124:785–791PubMedGoogle Scholar
  15. 15.
    Hardin JA, Steere AC, Malawista SE (1979) Immune complexes and the evolution of Lyme arthritis. Dissemination and localization of abnormal C1q binding activity. N Engl J Med 301:1358–1363PubMedGoogle Scholar
  16. 16.
    Schutzer SE, Coyle PK, Reid P, Holland B (1999) Borrelia burgdorferi-specific immune complexes in acute Lyme disease. JAMA 282:1942–1946CrossRefPubMedGoogle Scholar
  17. 17.
    Brunner M, Sigal LH (2001) Use of serum immune complexes in a new test that accurately confirms early Lyme disease and active infection with Borrelia burgdorferi. J Clin Microbiol 39:3213–3221CrossRefPubMedGoogle Scholar
  18. 18.
    Schutzer SE, Natelson BH (1999) Absence of Borrelia burgdorferi-specific immune complexes in chronic fatigue syndrome. Neurology 53:1340–1341PubMedGoogle Scholar
  19. 19.
    Wang P, Hilton E (2001) Contribution of HLA alleles in the regulation of antibody production in Lyme disease. Front Biosci 6:10–16Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • T. G. Berger
    • 1
  • C. Schoerner
    • 2
  • H. Schell
    • 1
  • M. SimonJr
    • 1
  • G. Schuler
    • 1
  • M. Röllinghoff
    • 2
  • A. Gessner
    • 2
    Email author
  1. 1.Dermatologische Klinik der Universität Erlangen-NürnbergErlangenGermany
  2. 2.Institut für Klinische MikrobiologieImmunologie und Hygiene der Universität Erlangen-NürnbergErlangenGermany

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