Borrelial lymphocytoma of the breast areola in a 52-year old man: An uncommon manifestation of Lyme disease

Borrelial pseudolymphoma of the nose

“…It is caused by tick bites and transmission of bacterium of the Borrelia genus 2. The clinical presentation is usually a solitary, diffusely erythaematous, painless, non-scaly plaque or nodule with rare association of extracutaneous symptoms3 and with an average interval of 5.5 weeks between the tick bite and the clinical cutaneous manifestation 4…”

“…It has been suggested that Borrelia spirochetes may have a tropism for cooler body sites 5. The clinical diagnosis of BL is highly suggestive considering the typical location and the history of the illness, but confirmation through laboratory testing is recommended 2. Histological criteria for diagnosis of BL include presence of a top-heavy, wedge-shaped mixed-cell lymphoid infiltrate, characterised by nodular clusters of B-lymphocytes (CD20+) with presence of (CD21+) follicular dendritic cells.…”

“…Culture is not routinely used, because its performance and outcome are inferior to the methods discussed above 7. The recommended first-line treatment for BL is oral amoxicillin (500 mg 3×/day for adults, 50 mg/kg per day for children) or oral doxycycline (200 mg per day) for 14–21 days 2 7Learning points

Atypical presentations of borrelial lymphocytoma are not uncommon and should be included in the differential diagnosis and work-up with biopsy and serology for erythaematous lesions of the face.

Biopsy is necessary to establish a diagnosis of pseudolymphoma.

The response to treatment with doxycycline 100 mg twice daily for 3 weeks in our case was as expected with a complete remission, underlining the need for a broad work-up of such clinical presentations to quickly initiate an appropriate treatment.

Patients may not give a history of tick bite and physicians should be aware of this in endemic areas.

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