Cutaneous borreliosis associated with T cell–predominant infiltrates: A diagnostic challenge
| Autor: | Dmitry V. Kazakov, Regula Schmid, Oliver Gugerli, Eugen Hübscher, Andreas W. Gerbig, Heinz Kutzner, Gabriele Palmedo, Werner Kempf |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
DNA Bacterial Male medicine.medical_specialty Pathology T-Lymphocytes Dermatology Diagnosis Differential Pseudolymphoma medicine Animals Humans Nuclear atypia Histiocyte Aged Retrospective Studies Skin Lyme Disease Mycosis fungoides Tick Bites Interstitial granulomatous dermatitis business.industry Acrodermatitis Cutaneous T-cell lymphoma Histiocytes Receptors Antigen T-Cell gamma-delta Skin Diseases Bacterial Middle Aged medicine.disease Fibrosis Leukemia Lymphocytic Chronic B-Cell Lymphoma T-Cell Cutaneous Erythema Borrelia burgdorferi Erythema migrans Female business Acrodermatitis chronica atrophicans |
| Zdroj: | Journal of the American Academy of Dermatology. 72:683-689 |
| ISSN: | 0190-9622 |
| DOI: | 10.1016/j.jaad.2014.12.014 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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