burgdorferi isolates from Slovenia, 1 was obtained from a patient with borrelial lymphocytoma
, and 4 were obtained from patients with acrodermatitis chronica atrophicans, a late disease manifestation.
Isolation of Borrelia burgdorferi sensu lato from blood of adult patients with borrelial lymphocytoma
, Lyme neuroborreliosis, Lyme arthritis and acrodermatitis chronica atrophicans.
Based on the clinical features and aforesaid investigations, the differential diagnoses of nodular/histoid leprosy, reticulohistiocytosis, subcutaneous sarcoidosis, cutaneous localised leishmaniasis, lymphocytoma
cutis, mycosis fungoides and post kala azar dermal Leishmaniasis were considered.
Aside from lymphocytoma
cutis, a significant B-cell infiltrate in the skin is rarely reactive and should suggest possible B-cell lymphoma.
The diagnosis of KD is not easy, and clinically differential diagnosis includes inflammatory and neoplastic conditions, tuberculosis, angiolymphoid hyperplasia with eosinophilia (AHLE), lymphocytoma
, Kaposi's sarcoma, epitheloid hemangioma, pyogenic granuloma and other infectious lymph node enlargements for example, toxoplasmosis.
Contact sensitivity to gold may result in lymphocytoma
, or granulomatous responses.
Differential diagnoses of ALHE include granuloma faciale, persistent insect bite reaction, injection site granuloma, cutaneous lymphoma, cavernous hemangioma, pyogenic granuloma, angiomatous lymphoid hamartoma, pseudolymphoma (lymphocytic infiltrate of Jessner, lymphocytoma
cutis), sarcoidosis and bacillary angiomatosis.
Grange F, Wechsler J, Guillaume JC, et al: Borrelia burgdorferi--associated lymphocytoma
cutis simulating a primary cutaneus large B-cell lymphoma.
The cutaneous manifestations seen in a retrospective study of 103 patients aged 1 15 years were erythema migrans (48 patients), disseminated erythema migrans(29 patients), borrelial lymphocytoma
(19 patients), combined borrelial lymphocytoma
and erythema migrans (6 patients), and acrodermatitis chronica atrophicans (1 patient).
Photo aggravated: Herpes simplex, systemic lupus erythematosus, dermatomyositis, pemphigus erythematosus, Darier's disease, erythema multiforme, pityriasis rubra pilaris, psoriasis, lichen planus, lymphocytoma
Some of them include Hansen's disease- tuberculoid pole, sarcoidosis, lupus vulgaris, chronic cutaneous lupus erythematosus (tumid LE and LE profundus), granuloma faciale and pseudolymphoma (cutaneous lymphoid hyperplasia or lymphocytoma
cutis and Jessner's lymphocytic infiltration of skin).