Header

UZH-Logo

Maintenance Infos

Cutaneous borreliosis associated with T cell-predominant infiltrates: a diagnostic challenge


Kempf, Werner; Kazakov, Dmitry V; Hübscher, Eugen; Gugerli, Oliver; Gerbig, Andreas W; Schmid, Regula; Palmedo, Gabriele; Kutzner, Heinz (2015). Cutaneous borreliosis associated with T cell-predominant infiltrates: a diagnostic challenge. Journal of the American Academy of Dermatology, 72(4):683-689.

Abstract

BACKGROUND With the exception of erythema migrans, Borrelia infection of the skin manifests much more commonly with B cell-rich infiltrates. T cell-rich lesions have rarely been described. OBJECTIVE We report a series of 6 patients with cutaneous borreliosis presenting with T cell-predominant skin infiltrates. METHODS We studied the clinicopathologic and molecular features of 6 patients with T cell-rich skin infiltrates. RESULTS Half of the patients had erythematous patchy, partly annular lesions, and the other patients had features of acrodermatitis chronica atrophicans. Histopathology revealed a dense, band-like or diffuse dermal infiltrate. Apart from small, well differentiated lymphocytes, there were medium-sized lymphocytes with slight nuclear atypia and focal epidermotropism. An interstitial histiocytic component was found in 4 cases, including histiocytic pseudorosettes. Fibrosis was present in all cases but varied in severity and distribution. In 5 patients, borrelia DNA was detected in lesional tissue using polymerase chain reaction studies. No monoclonal rearrangement of T-cell receptor gamma genes was found. LIMITATIONS This retrospective study was limited by the small number of patients. CONCLUSION In addition to unusual clinical presentation, cutaneous borreliosis can histopathologically manifest with a T cell-rich infiltrate mimicking cutaneous T-cell lymphoma. Awareness of this clinicopathologic constellation is important to prevent underrecognition of this rare and unusual presentation representing a Borrelia-associated T-cell pseudolymphoma.

Abstract

BACKGROUND With the exception of erythema migrans, Borrelia infection of the skin manifests much more commonly with B cell-rich infiltrates. T cell-rich lesions have rarely been described. OBJECTIVE We report a series of 6 patients with cutaneous borreliosis presenting with T cell-predominant skin infiltrates. METHODS We studied the clinicopathologic and molecular features of 6 patients with T cell-rich skin infiltrates. RESULTS Half of the patients had erythematous patchy, partly annular lesions, and the other patients had features of acrodermatitis chronica atrophicans. Histopathology revealed a dense, band-like or diffuse dermal infiltrate. Apart from small, well differentiated lymphocytes, there were medium-sized lymphocytes with slight nuclear atypia and focal epidermotropism. An interstitial histiocytic component was found in 4 cases, including histiocytic pseudorosettes. Fibrosis was present in all cases but varied in severity and distribution. In 5 patients, borrelia DNA was detected in lesional tissue using polymerase chain reaction studies. No monoclonal rearrangement of T-cell receptor gamma genes was found. LIMITATIONS This retrospective study was limited by the small number of patients. CONCLUSION In addition to unusual clinical presentation, cutaneous borreliosis can histopathologically manifest with a T cell-rich infiltrate mimicking cutaneous T-cell lymphoma. Awareness of this clinicopathologic constellation is important to prevent underrecognition of this rare and unusual presentation representing a Borrelia-associated T-cell pseudolymphoma.

Statistics

Citations

4 citations in Web of Science®
3 citations in Scopus®
Google Scholar™

Altmetrics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Dermatology Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:April 2015
Deposited On:03 Dec 2015 16:12
Last Modified:08 Dec 2017 15:34
Publisher:Elsevier
ISSN:0190-9622
Publisher DOI:https://doi.org/10.1016/j.jaad.2014.12.014
PubMed ID:25617014

Download

Full text not available from this repository.
View at publisher