A Case of Generalized Morphea with a High Titer of Anti‐Borrelia burgdorferi Antibodies

Abstract

A 69-year-old male had noticed pruritus on the back for the previous 3-4 years and cutaneous sclerosis with swelling of the dorsum of the neck had developed in the last one and a half years. However, he had never complained of Raynaud's phenomenon of the fingers, dry mouth, or dry eyes. At this first visit to our hospital, he complained of erythematous cutaneous sclerosis with swelling of the dorsum of the neck. Histopathological findings biopsied from the neck showed epidermal hyperplasia with elongation of rete ridges and homogeneous and fibromatous changes of the dermis with dense perivascular cell infiltration consisting of mononuclear cells or lymphocytes with several nests of incontinentia pigmenti. However, there were no sclerotic changes in blood vessels in the upper dermis biopsied from the forearm skin, although slightly homogeneous and fibromatous changes of the dermis were seen. In the clinical course, the cutaneous sclerotic change enlarged to extend to the bottom of the cheek, forearm, and lower legs. These clinical features and histopathological findings led to the diagnosis of generalized morphea. Hematologic examination showed positive anti-Borrelia burgdorferi IgM antibodies, although there were no positive anti-Borrelia burgdorferi IgG antibodies. These results revealed that there can be a close association of localized scleroderma with Borrelia burgdorferi and that generalized morphea may also represent a Borrelia infection.

Lack of IgG antibody seropositivity to Borrelia burgdorferi in patients with Parry–Romberg syndrome and linear morphea en coup de sabre in Mexico

“…Similarly, in six patients with LMCS, such a relationship could not be found. It is not always possible to differentiate LMCS and PRS on a clinical basis, and there is controversy as to whether they are part of the same spectrum or represent different entities . However, our patients' clinical diagnosis was supported by histopathological criteria applied to translesional biopsies, thus allowing clear differentiation between diseases.…”

“…Most published studies have been performed in smaller groups or on a retrospective basis . Ever since a possible relation between Borrelia and morphea was suggested, contradictory results have failed to demonstrate a relation to the spirochete …”

“…On the other hand, PRS and linear morphea en coup de sabre (LMCS) may coexist, and although their association is not clear, some authors consider them as variants of scleroderma, while others support the concept that they are different diseases . As a possible relation emerged between infection and seropositivity to Borrelia burgdorferi with PRS and morphea, borreliosis has been etiologically considered. This concept remains controversial, and a set of evidence either supports or rejects this association .…”

Infections Are Not Increased in Scleroderma Compared to Non-Inflammatory Musculoskeletal Disorders Prior to Disease Onset

“…Borrelia burgdorferi (Bb) has been implicated in generalized morphea [25]. Additionally, an earlier study found 38% of seropositive (n=5) and 23% of seronegative (n=26) patients with morphea exhibited elevated B.burgdorferi induced lymphocyte proliferation, supporting a causal role, at least for some patients with morphea [26].…”

Systemic and Localized Scleroderma in Children

“…[109] Other localized sceleroderma represents undetected B. burgdorferi infectrials have confirmed both promising results and high treatmenttion. [130][131][132][133][134] related mortality. Stem cell transplantation continues to be evalu-…”