Peripheral neuropathy in acrodermatitis chronica atrophicans - a late Borrelia manifestation

Abstract

Clinical and/or neurophysiological signs of peripheral neuropathy were found in 64% of 63 consecutive untreated patients with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA). The neuropathy frequency was significantly higher in the patients than in 30 age- and sex-matched control persons of whom 27% had neuropathy findings. The most common neuropathy in ACA was a symmetric distal sensory polyneuropathy. In a subgroup of patients with localized or asymmetric neuropathy, the changes were found more often in extremities with than without visible ACA lesions. Neuropathy symptoms, most often pain and/or paresthesia, were present in 64% of the patients, compared to in 13% of the control persons. Thus, both symptoms and signs of neuropathy were significantly more frequent in patients with untreated ACA than in control subjects.

Acrodermatitis chronica atrophicans in a 15-year-old girl misdiagnosed as venous insufficiency for 6 years

“…1,5,12 In 10% to 20% of patients with ACA, localized increase of dermal collagen leads to juxtaarticular fibrotic nodules and/or patchy or bandlike induration, which can lead to limitations of joint movement. 5,13 Extracutaneous complications include mononeuropathy or polyneuropathy in approximately 60% of patients, 6 subluxations and/or luxations of small joints of the hands or feet, arthritis in large joints, bursitis, and Achilles tendinitis. 1,5 Because of the progressive course and the potential for extracutaneous complications, prompt diagnosis and treatment of ACA are essential.…”

“…[2][3][4] It is important to diagnose and treat ACA as promptly as possible because expansion of skin changes, irreversible damage of epidermal and dermal structures, and extracutaneous signs and symptoms occur in the vast majority of patients after a longer disease duration. 1,5,6 ACA has many features that overlap with those of chronic venous insufficiency, 7 the advanced stage of incompetence of the venous system of the legs that is clinically characterized by varicose veins, bluish-red discoloration, edema, chronic inflammation of the dermis and subcutis with secondary eczema, hyperpigmentation, dermatosclerosis, and leg ulcers. 8 The prevalence in the adult population is 15%, but it occurs only occasionally in childhood.…”

Lyme disease

“…188,233 The polyneuropathy, which is primarily axonal, involves the distal extremities and may be associated with ACA. 188,233,234 Cases with hemiparesis 235 and acute transverse myelitis 236 have also been recognized.…”

Borrelial Lymphocytoma and Acrodermatitis Chronica Atrophicans

“…A peripheral neuropathy of mild to moderate severity develops in about 60% of patients (Kindstrand et al, 1997). This is usually sensory, but a motor neuropathy can occur and usually follows the distribution of the cutaneous ACA lesions.…”