Bb & scleroderma, localized & circumscribed

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Rheum Dis Clin North Am. 1989 Nov;15(4):649-56. Related Articles, Links

Lyme disease: musculoskeletal manifestations.

Kolstoe J, Messner RP.

Section of Rheumatology, University of Minnesota School of Medicine,

Minneapolis.

A previously unrecognized musculoskeletal syndrome led to the recognition of

this " new " infectious disease. Several distinct patterns of musculoskeletal

involvement can be seen throughout the course of untreated Lyme disease.

Diffuse, nonspecific muscle achiness and stiffness can be seen early to be

followed by characteristically brief, recurrent episodes of LIMP and

transient arthritis that help to differentiate LD from other arthropathies.

Chronic oligoarticular arthritis is seen in a few. Lyme arthropathy most

closely resembles the reactive arthropathies. In a few cases, LD has

mimicked other connective tissue disorders such as juvenile rheumatoid

arthritis, rheumatoid arthritis, myositis, and scleroderma. It would appear

that the full spectrum of musculoskeletal LD is still being defined.

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PMID: 2685923 [PubMed - indexed for MEDLINE]

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Br J Dermatol. 1996 Feb;134(2):285-91. Related Articles, Links

Lymphoproliferative responses to Borrelia burgdorferi in circumscribed

scleroderma.

Breier P, Klade H, Stanek G, Poitschek C, Kirnbauer R, Dorda W, Aberer E.

Department of Dermatology, University of Vienna, Austria.

Humoral immune responses to Borrelia burgdorferi (Bb) have been reported to

occur in certain patients with circumscribed scleroderma (CS) (morphoea).

Together with the isolation of spirochaetes from CS skin biopsies, this

finding was taken to suggest Bb as the aetiological agent of CS. Since there

is cellular immunoreactivity to Bb in patients with chronic Lyme borreliosis

(LB), Bb-specific lymphocytic responses were tested in patients with CS. For

this purpose, peripheral blood mononuclear cells from CS patients and, as

controls, from patients with various manifestations of LB, and from healthy

volunteers without any evidence of Bb infection, were exposed to Bb

organisms for 5 days and then assayed for DNA synthesis. Stimulation indices

(SI) > 10 were scored positive. By performing lymphocyte proliferation tests

we found: (i) that not only patients with various manifestations of LB but

also a considerable percentage of seropositive (five of 13 = 38%) and

seronegative (six of 26 = 23%) CS patients exhibit an elevated Bb-induced

lymphocyte proliferation; (ii) that the magnitude of the cellular response

seen in CS patients is comparable to that encountered in patients with

established Bb manifestations; and (iii) that, within a given patient,

antibiotic therapy can result in a significant reduction of this response.

These results support a causative role of Bb in at least some CS patients.

Bb-induced lymphocyte responses were also seen in both seropositive and

seronegative erythema chronicum migrans patients. These findings show that

the pattern of Bb-specific immune responses is more complex than previously

thought, and underscore the importance of lymphocyte function assays in

evaluating the diagnosis of potential Bb infection in seronegative patients.

PMID: 8746343 [PubMed - indexed for MEDLINE]

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Hautarzt. 1994 Mar;45(3):171-5. Related Articles, Links

[sclerodermiform skin changes in Borrelia burgdorferi infection. Diagnostic

use of polymerase chain reaction]

[Article in German]

Weidenthaler B, Roux M, Moter SE, Schulze HJ, Kramer MD.

Institut fur Immunologie und Serologie, Universitat Heidelberg.

We report on a 61-year-old patient with sclerodermiform skin lesions of the

extremities and polyneuropathy. Borrelia (B.) burgdorferi DNA was detected

in lesional skin by the polymerase chain reaction. Serological testing

revealed IgG antibodies to B. burgdorferi. Histology revealed an

inflammatory stage of a sclerotic reaction in the lesional skin. The

admixture of plasma cells and the perineural distribution of the cellular

infiltrate was suggestive for a borrelia infection. Immunohistochemical

staining for the B. burgdorferi flagellin (41 kDa) revealed a positive

staining reaction in the epidermis of lesional skin. The improvement of both

the dermatological and the neurological symptoms upon antibiotic treatment

with ceftriaxone was taken as further support for the diagnosis of a. B.

burgdorferi infection.

PMID: 8175346 [PubMed - indexed for MEDLINE]

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J Am Acad Dermatol. 1993 Aug;29(2 Pt 1):190-6. Related Articles, Links

Localized scleroderma associated with Borrelia burgdorferi infection.

Clinical, histologic, and immunohistochemical observations.

Buechner SA, Winkelmann RK, Lautenschlager S, Gilli L, Rufli T.

Department of Dermatology, University of Basel, Switzerland.

BACKGROUND: Recent reports have implicated Borrelia burgdorferi infection as

a possible cause of localized scleroderma (LS). OBJECTIVE: Our purpose was

to describe the clinical, histologic, and immunopathologic features of

patients with LS who had serum antibodies to B. burgdorferi. METHODS: Ten

patients were examined clinically and by routine microscopy. Biopsy

specimens from seven patients were studied immunohistochemically with

monoclonal antibodies. The proliferative response of peripheral blood

mononuclear cells to B. burgdorferi was investigated in seven patients by

lymphocyte proliferation assay. RESULTS: Seven patients had plaque-type

morphea, and three patients had linear scleroderma. Two patients had a

history of previous erythema migrans. One patient had coexistent

acrodermatitis chronica atrophicans, and in two patients lichen sclerosus et

atrophicus was observed. Histologically, a prominent inflammatory phase with

sclerosis of the connective tissue was shown in all patients.

Immunohistochemical studies revealed that the inflammatory infiltrates

consisted of both B and T lymphocytes, predominantly of the CD4+ subset. All

10 patients had strongly elevated serum antibodies to B. burgdorferi.

Patients with LS showed significantly elevated lymphoproliferative responses

to B. burgdorferi when compared with healthy control subjects. CONCLUSION:

Our findings suggest that some cases of LS are linked to Borrelia infection.

PMID: 8335737 [PubMed - indexed for MEDLINE]

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Enferm Infecc Microbiol Clin. 1991 Aug-Sep;9(7):394-8. Related Articles,

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[Localized scleroderma (morphea) and septic arthritis. Clinical

manifestations of Lyme borreliosis seen in El Ferrol]

[Article in Spanish]

Maestre JR, Almagro M, ez P, de Casas R, Quesada R, Egido J.

Servicio de Microbiologia Clinica, Hospital Naval de El Ferrol.

Two cases of Lyme's disease seen at El Ferrol (Spain) were described. One of

them developed a recurrent knee arthritis and the other had a localized

sclerodermia (morphea) syndrome. Diagnosis was established by means of

clinical picture and serologic tests (enzyme-linked analysis and/or indirect

immunofluorescence tests). Joint involvement has often been described in

patients diagnosed of having Lyme's disease in Spain, however, the

relationship between morphea and borreliosis is still a matter of

controversy. We believe that patients with localized sclerodermia and high

significant titers of specific antibodies against B. burgdorferi should be

treated with antimicrobial agents.

PMID: 1799607 [PubMed - indexed for MEDLINE]

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Ann N Y Acad Sci. 1988;539:65-79. Related Articles, Links

Clinical pathologic correlations of Lyme disease by stage.

Duray PH, Steere AC.

Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania

19111.

Lyme disease is capable of producing a wide variety of clinical pathologic

conditions and lesions having in common histologic features of

collagen-vascular disease. The plasma cell is an omnipotent inflammatory

responder in most tissues involved by Lyme disease, ranging from relatively

acute to lesions that have gone on for years. Vascular thickening also seems

to be prominent, and in the dermis is accompanied by scleroderma-like

collagen expansion. The disease in some ways resembles the responses seen in

lupus erythematosus such as mild cerebritis with lymphocytes and plasma

cells in the leptomeninges. Lymphoplasmacytic panniculitis of Lyme disease

resembles lupus profundus, both in the infiltrate and the plasma cell-blood

vessel relationship. The onion skin thickened vessels of the synovia

resemble the vessels of lupus spleens, while the scleradermoid thickening of

the dermis and various skin lesions of stage III Lyme disease suggest a

collagen-vascular disorder. Finally, the perivascular lymphoid infiltrate in

clinical myositis does not differ from that seen in polymyositis or

dermatomyositis. All of these histologic derangements suggest immunologic

damage in response to persistence of the spirochete, however few in number.

PMID: 2847622 [PubMed - indexed for MEDLINE]