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Skin-nontumor / Clinical Dermatology

Infectious disorders

Lyme disease

Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 22 March 2011, last major update March 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● Multisystem disorder caused by spirochete Borrelia burgdorferi


● Usually transmitted by Ixodes dammini tick mite

Clinical features

● Causes erythema chronicum migrans (red papule with central clearing that expands slowly), acrodermatitis chronica atrophicans (disease of extremities, usually women, with erythematous, edematous, pruritic phase, followed by sclerosis and atrophy), cutaneous lymphoid hyperplasia of skin
● Also affects heart, joints, nervous system

Disease stages:
● Stage 1: skin lesion (erythema chronicum migrans)
● Stage 2: cardiovascular and nervous system involvement
● Stage 3: arthritis stage characterized by migratory polyarthritis; however, cutaneous lesions and peripheral nervous system involvement are also encountered in this stage

Case reports

● Butterfly rash in a young boy (Acta Derm Venereol 2010;90:109)

Clinical images

Erythema chronicum migrans

Micro description

● Superficial and deep perivascular polymorphic infiltrate of neutrophils, lymphocytes, plasma cells, eosinophils and mast cells
● Vascular proliferation and dermal necrosis may be present
● Identification of the spirochetes by silver stain is diagnostic
● PCR can also be used for diagnosis

Positive stains

● Warthin-Starry (for spirochetes)

End of Skin-nontumor / Clinical Dermatology > Infectious disorders > Lyme disease

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