Isolation and polymerase chain reaction typing of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcerating bullous lichen sclerosus et atrophicus

Abstract

A 64-year-old woman presented with bullous and ulcerating lichen sclerosus et atrophicus (LSA) on the neck, trunk, genital and perigenital area and the extremities. Histology of lesional skin showed the typical manifestations of LSA; in one of the biopsies spirochaetes were detected by silver staining. Despite treatment with four courses of ceftriaxone with or without methylprednisone for up to 20 days, progression of LSA was only stopped for a maximum of 1 year. Spirochaetes were isolated from skin cultures obtained from enlarging LSA lesions. These spirochaetes were identified as Borrelia afzelii by sodium dodecyl sulphate--polyacrylamide gel electrophoresis and polymerase chain reaction (PCR) analyses. However, serology for B. burgdorferi sensu lato was repeatedly negative. After one further 28-day course of ceftriaxone the lesions stopped expanding and sclerosis of the skin was diminished. At this time cultures for spirochaetes and PCR of lesional skin for B. afzelii DNA remained negative. These findings suggest a pathogenetic role for B. afzelii in the development of LSA and a beneficial effect of appropriate antibiotic treatment.

Antimicrobial susceptibility of Borrelia burgdorferi sensu lato: What we know, what we don't know, and what we need to know

“…Reactivation of infection during this culture-negative state obviously occurs spontaneously or following immunosuppression after the conclusion of treatment. Such reactivation is similarly documented for LB and syphilis [12,14,54,67,76]. In addition, B. burgdorferi s.l.…”

Possible Role of Borreliaburgdorferi Sensu Lato Infection in Lichen Sclerosus

“…[8][9][10][11][12][13][14][15][16][17][18][19][20] A bacterial cause was further suggested because several cases of LS responded well to therapy with antibiotics, such as dirithromycin, penicillin, and ceftriaxone. 20,36,37 In the present study, we detected B burgdorferi sensu lato in more than 60% of all LS cases, with a significantly higher percentage (P=.001) in early (80%) than in late (33%) LS, while it made no difference whether LS was associated with morphea. This might reflect intentional or coincidental antibiotic exposure in longerterm cases and/or the natural course of disease, with repression of the microorganism by the immune system.…”

“…Studies reporting a positive association between B burgdorferi infection and LS found evidence of the organism in 10% to 68% of cases; on the other hand, there are reports in which no positive cases could be identified ( Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20] One main difficulty in assessing the association between LS and borreliosis is the…”

Perianale Ulzera bei einem Kind

“…Als Ursachen werden unter anderem eine Borreliose [4,5], Hepatitis C [6], Störungen der Androgenregulation, Autoimmunprozesse sowie genetisch determinierte Anfälligkeit [7] diskutiert. Eine retrospektive Studie zeigte beim Lichen sclerosus der Vulva eine Assoziation mit Autoimmunerkrankungen, vor allem aber in einem Großteil der Fälle mit einer positiven Familienanamnese für einen Lichen sclerosus [1].Auch wird über die Induktion eines Lichen sclerosus et atrophicus durch Strahlentherapie berichtet [8].…”