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Cutaneous borreliosis associated with T cell-predominant infiltrates: a diagnostic challenge.

AbstractBACKGROUND:
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.
AuthorsWerner Kempf, Dmitry V Kazakov, Eugen Hübscher, Oliver Gugerli, Andreas W Gerbig, Regula Schmid, Gabriele Palmedo, Heinz Kutzner
JournalJournal 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
PMID25617014 (Publication Type: Case Reports, Journal Article)
CopyrightCopyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
Chemical References
  • DNA, Bacterial
  • Receptors, Antigen, T-Cell, gamma-delta
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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