Abstract | BACKGROUND: With the exception of erythema migrans, Borrelia infection of the skin manifests much more commonly with B cell-rich infiltrates. T cell-rich lesions have rarely been described. OBJECTIVE: We report a series of 6 patients with cutaneous borreliosis presenting with T cell-predominant skin infiltrates. METHODS: We studied the clinicopathologic and molecular features of 6 patients with T cell-rich skin infiltrates. RESULTS: Half of the patients had erythematous patchy, partly annular lesions, and the other patients had features of acrodermatitis chronica atrophicans. Histopathology revealed a dense, band-like or diffuse dermal infiltrate. Apart from small, well differentiated lymphocytes, there were medium-sized lymphocytes with slight nuclear atypia and focal epidermotropism. An interstitial histiocytic component was found in 4 cases, including histiocytic pseudorosettes. Fibrosis was present in all cases but varied in severity and distribution. In 5 patients, borrelia DNA was detected in lesional tissue using polymerase chain reaction studies. No monoclonal rearrangement of T-cell receptor gamma genes was found. LIMITATIONS: This retrospective study was limited by the small number of patients. CONCLUSION: In addition to unusual clinical presentation, cutaneous borreliosis can histopathologically manifest with a T cell-rich infiltrate mimicking cutaneous T-cell lymphoma. Awareness of this clinicopathologic constellation is important to prevent underrecognition of this rare and unusual presentation representing a Borrelia-associated T-cell pseudolymphoma.
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Authors | Werner Kempf, Dmitry V Kazakov, Eugen Hübscher, Oliver Gugerli, Andreas W Gerbig, Regula Schmid, Gabriele Palmedo, Heinz Kutzner |
Journal | Journal of the American Academy of Dermatology
(J Am Acad Dermatol)
Vol. 72
Issue 4
Pg. 683-9
(Apr 2015)
ISSN: 1097-6787 [Electronic] United States |
PMID | 25617014
(Publication Type: Case Reports, Journal Article)
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Copyright | Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- DNA, Bacterial
- Receptors, Antigen, T-Cell, gamma-delta
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Topics |
- Acrodermatitis
(etiology)
- Adult
- Aged
- Animals
- Borrelia burgdorferi
(isolation & purification)
- DNA, Bacterial
(isolation & purification)
- Diagnosis, Differential
- Erythema
(etiology)
- Female
- Fibrosis
- Histiocytes
(pathology)
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell
(complications)
- Lyme Disease
(complications, diagnosis, immunology, pathology, transmission)
- Lymphoma, T-Cell, Cutaneous
(diagnosis)
- Male
- Middle Aged
- Pseudolymphoma
(diagnosis, immunology, pathology)
- Receptors, Antigen, T-Cell, gamma-delta
(genetics)
- Retrospective Studies
- Skin
(immunology, microbiology, pathology)
- Skin Diseases, Bacterial
(diagnosis, immunology, pathology)
- T-Lymphocytes
(pathology)
- Tick Bites
(complications, microbiology, pathology)
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