Acta Dermato-Venereologica Issue No. 97-5 97-5CompleteContent | Page 29

660 SHORT COMMUNICATION Borrelia-associated Fasciitis: Two Cases Caroline LANG, Isabelle MASOUYÉ, Michael MÜHLSTÄDT, Sandrine QUENAN, Gürkan KAYA and Emmanuel LAFFITTE Department of Dermatology, University Hospital of Geneva, CH-1205 Genève, Switzerland. E-mail: [email protected] Accepted Feb 7, 2017; Epub ahead of print Feb 8, 2017 Late manifestation of infection with Borrelia species can induce several cutaneous symptoms due to the abi- lity of Borrelia spp. to colonize and induce structural changes in the collagen fibres (1). The classical form is acrodermatitis chronica atrophicans, but infection with Borrelia spp. has also been related to morphoea (2), li- chen sclerosus et atrophicus (3) and, rarely, eosinophilic fasciitis (EF) (4–7). Diagnosis is mainly clinical, and a deep skin biopsy can reveal a typical lymphoplasmacytic infiltrate. Serology is very sensitive (95–99%), but does not provide any information about the activity of the disease. PCR on skin biopsies is a useful tool for the diagnosis of early stage skin borreliosis when there is a high load of Borrelia present in the skin, but its sensi- tivity decreases during the course of the infection (8). A relatively new test, using antibodies targeting VlsE, a lipoprotein expressed by Borrelia spp. implicated in escaping the immune system, correlates with the disease activity and is a useful tool for follow-up of the efficiency of the treatment. The test is highly specific, but not very sensitive (9–11). We report here 2 cases of fasciitis as- sociated with Borrelia spp. infection. Fig. 1. Diffuse cutaneous fibrosis of the right foot and right thigh (Case 1). CASE REPORTS Case 1 A 70-year-old man presented with widespread deep cutaneous sclerosis of the limbs (Fig. 1) associated with fatigue, arthralgia and night sweats. He remembered having had a tick bite in Swe- den several months earlier. A computed tomography (CT) scan revealed a bilateral infiltration of the superficial and deep fascia of both thighs. A deep biopsy of the skin and subcutaneous tissue including the fascia and some superficial muscle tissue showed a moderate perivascular and interstitial inflammatory infiltrate composed of lymphocytes and plasma cells throughout the dermis, extending into the fascia and skeletal muscle. There was no blood eosinophilia. Western blot was positive for Borrelia spp. IgG and anti-VlsE were strongly positive. PCR for Borrelia spp. on deep skin biopsy, synovial liquid and cerebrospinal fluid were negative. Fasciitis associated with Borrelia spp. infection was diagnosed; intravenous ceftriaxone, 2 g once daily, was administered for one month, with a positive biological response showing a decreasing anti-VlsE level. Clinically, there was a significant improvement, but the persistence of sclerosis, oedema of the limbs and arthralgia required additional treatment with prednisone and methotrexate. Case 2 A 79-year-old woman presented with non-pruriginous erythema- tous lesions with sclerotic changes of the skin involving the thighs, groin, abdomen, axillary regions and breasts (Fig. 2) She reported having had a tick bite on the left groin one year earlier. Labora- tory tests revealed an eosinophilia, a slightly elevated C-reactive doi: 10.2340/00015555-2627 Acta Derm Venereol 2017; 97: 660–662 Fig. 2. Sclerotic erythematous lesions involving the flanks, the lumbosacral area, the abdomen and the axillary regions (Case 2). This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica.