Lyme borreliosis presenting as acrodermatitis chronica atrophicans.

A patient is described who developed acrodermatitis chronica atrophicans, arthralgias and polyneuropathy as manifestations of Lyme borreliosis. The clinical diagnosis was confirmed by histological and serological examinations. Despite a long delay before the diagnosis was established, the patient responded very well to treatment with doxycycline.     

Success and failure in the treatment of acrodermatitis chronica atrophicans

Summary To determine the most effective treatment for acrodermatitis chronica atrophicans, several clinical trials were undertaken in recent years to evaluate whether a 2-week course of ceftriaxone would be superior to oral antibiotics. Of the 46 patients suffering from acrodermatitis chronica atrophicans, 14 were treated with ceftriaxone 2g for 15 days. The remaining patients received either oral penicillin V 1.5 million IU t.i.d. or doxycycline 100 mg b.i.d. for 20 to 30 days. Patients were followed up for at least 1 year. Of the 14 ceftriax-one-treated patients four showed incomplete regression of the inflammatory skin changes after 6 to 12 months. Two out of five patients who were monitored forBorrelia burgdorferi DNA excretion were still positive after 12 months as compared to none of six patients who were treated orally for 20–30 days. Six out of 11 patients treated orally for only 20 days needed retreatment after 6 months because of continuing skin manifestations, neuropathy or arthralgia. A 30-day duration of treatment with oral antibiotics and not the chosen antibiotic is crucial for curing acrodermatitis chronica atrophicans. The duration of treatment with ceftriaxone needed for eradication ofBorrelia in acrodermatitis chronica atrophicans has yet to be determined in future studies.

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Welche Therapie führt bei der Acrodermatitis chronica atrophicans zur Abheilung?

Zusammenfassung In den letzten Jahren wurden verschiedene Therapiekonzepte zur optimalen Behandlung der Acrodermatitis chronica atrophicans durchgeführt. Aus einer Gruppe von 46 Patienten erhielten 14 Ceftriaxon 2g für 15 Tage, die übrigen Patienten Penicillin V 1,5 Mill. IE 3×1 oder Doxycyclin 100 mg 2×1 durch 20–30 Tage. Vier der 14 Patienten, die mit Ceftriaxon über nur 15 Tage behandelt worden waren, zeigten bei einer Kontrolle nach 6–12 Monaten eine inkomplette Rückbildung der Hautveränderungen. Zwei von fünf mit Ceftriaxon behandelten Patienten wiesen nach 12 Monaten eine Borrelien-DNA Ausscheidung im Harn auf. Im Vergleich dazu konnten aus dem Harn von sechs Patienten, die orale Antibiotika über 20–30 Tage erhalten hatten, nach dem gleichen Zeitraum keine Borrelien-DNA Fragmente amplifiziert werden. Sechs von 11 Patienten, die oral über 20 Tage behandelt worden waren, mußten jedoch aufgrund anhaltender entzündlicher Hautveränderungen, Neuropathie oder Arthralgien ein zweites Mal therapiert werden. Wir schließen aus den Ergebnissen, daß der Therapieerfolg bei der Acrodermatitis chronica atrophicans nicht so sehr von der Wahl des Antibiotikums sondern vielmehr von einer Therapiedauer von 30 Tagen abhängt. Der Behandlungserfolg einer möglicherweise kürzeren Behandlungsdauer mit Ceftriaxon muß noch in weiteren Studien erprobt werden.

     

Usefulness of laboratory investigations for the diagnosis of acrodermatitis chronica atrophicans.

The authors report a clinical case of acrodermatitis chronica atrophicans in a 65 year old diabetic woman. The characteristic cutaneous lesion restricted to the dorsal aspect of the left hand has been evolved since two years, together with a progressive development of a typical Dupuytren disease. This yielded a contracture of the last 3 phalanges of the same left hand. Confirmatory techniques included the histology of the skin, the reactivity of specific-IgG antibodies showing high avidity and Western blot. Of this, the immunodominant antigens which were extracted from 3 genospecies of Borrelia sensu lato i.e. Bb sensu stricto, Bb garinii, Bb afzelii were compatible with past infection. Apart from the diabetic status which may have predisposed the patient to the development of Dupuytren disease, the authors question about the potential role of Borrelia burgdorferi in the occurrence of this associated disease.     

Joint and bone involvement in Dutch patients with Lyme borreliosis presenting with acrodermatitis chronica atrophicans

We report on the radiological abnormalities of bones and joints in Dutch patients suffering from Lyme borreliosis presenting with acrodermatitis chronica atrophicans (A.C.A.). In a highly endemic area of the Netherlands rheumatic complaints were mentioned by 26 out of 60 patients suffering from a late stage of Lyme disease. Radiological findings in our group of patients were subluxation of the toe joint and periostitis of the bones of the lower limb.     

Acrodermatitis enteropathica

A brief review of the clinical and biochemical features of Acrodermatitis enteropathica is given. This condition is now known to be caused by a systemic zinc deficiency secondary to a defect in the intestinal absorption of zinc and it illustrates the metabolic importance of this element in man.     

Degos' papulosis atrophicans maligna

This article describes a very seldom mortal disease; its typical effluorescences of the skin however, make it possible to make a diagnostic just on behalf of the macromorphology.     

血管萎缩性皮肤异色病合并肝硬化1例报告

<正>1病例资料患者男性,31岁,主诉为"9个月间断呕血4次,腹部胀痛10 d"。该患者曾因反复消化道出血入院,此次因腹胀明显就诊于吉林大学白求恩第一医院肝胆胰内科。曾行胃镜检查提示食管胃底静脉曲张、门静脉高压,腹部彩超提示"肝硬化、脾大、门静脉高压",2013年2月行脾栓塞治疗(栓塞40%)。既往:儿童时期曾诊断为"肠病性肢端皮炎";颈、躯干部皮肤黑变14年余,渐加重,2012年8月行颈部皮肤活组织检查,病理     

Isolation of <Emphasis Type="Italic">Borrelia burgdorferi</Emphasis> sensu lato from blood of adult patients with borrelial lymphocytoma,Lyme neuroborreliosis,Lyme arthritis and acrodermatitis chronica atrophicans

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.     

Acrodermatitis Chronica Atrophicans Herxheimer Can Often Mimic a Peripheral Vascular Disorder

ABSTRACT During the past few years five patients have been referred to the angiology section at Danderyd Hospital under the diagnosis of chronic venous insufficiency but who were instead suffering from acrodermatitis chronica atrophicans (ACA). The typical case of ACA starts with a limited inflammatory lesion, which is gradually replaced by atrophy and the skin shows a bluish, red discoloration. Late changes may be subluxation of joints in hands or feet and periosteal thickening. Capillary microscopy often reveals a clear picture of atrophy and a prominent, dilated subpapillary venular plexus. If localized to the leg the blood flow of the foot and lower leg may be increased, skin temperature elevated and venous capacity and return augmented. All these variables can consequently mimic venous insufficiency of the leg. ACA is caused by a Borrelia infection and serological testing will always show a significantly elevated titer to Borrelia. The disease is most often easily cured by 2–3 g of penicillin daily for two to three weeks.     

Die Beziehungen zwischen Mastopathia chronica cystica und Fibroadenom der Mamma zum Mammacarcinom

Zusammenfassung Sowohl Mastopathia fibrocystica als auch Mamma-Fibroadenom sind morphologisch präcanceröse Gewebsveränderungen, aus denen sich besondere Krebse bilden.Die Brustkrebse können in folgender Weise unterteilt werden: Carcinoma ex fibroadenoma (16,09%), Carcinoma ex mastopathia (37,56%), von Fibroadenom und Mastopathie unabhängige Krebse (46,35%).Es wird aus gutem Grund angenommen, daß die Induktionszeit des Carcinoma ex fibroadenoma ungefähr 20 Jahre ausmacht, die des Carcinoma ex mastopathia ungefähr 8 Jahre beträgt.Zentrum für die Diagnose und Behandlung bösartiger Tumoren, Histopathologische Abteilung