title: Spirochetes in atrophic skin lesions accompanied by minimal host response in a child with Lyme disease.
abstract: Acrodermatitis chronica atrophicans, which has rarely been observed in the United States, is a late skin manifestation of Lyme borreliosis. A 12-year-old girl who spent summers on Cape Cod presented with a 2-year history of hyperpigmentation and atrophy of the skin on the hands, wrists, and ankles. The skin biopsy specimen of an affected area showed mild dermal fibrosis, a few inflammatory cells, and spirochetes morphologically compatible with Borrelia burgdorferi. An IgG antibody response to B. burgdorferi could be elicited by immunoblotting, but not by enzyme-linked immunosorbent assay. We conclude that this patient had chronic Lyme borreliosis manifested only by indolent infection of the skin.
authors.affiliation: Department of Dermatology, Pathology, Tufts University School of Medicine, Boston, MA.
authors.forename: S E
authors.initials: SE
authors.lastname: Gellis
authors.forename: M J
authors.initials: MJ
authors.lastname: Stadecker
authors.forename: A C
authors.initials: AC
authors.lastname: Steere
mesh_terms: D000169:Acrodermatitis / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D000842:Ankle; D000907:Antibodies, Bacterial / Q000032:analysis; D001284:Atrophy; D015748:Borrelia burgdorferi Group / Q000276:immunology / Q000302:isolation & purification*; D002648:Child; D002908:Chronic Disease; D005260:Female; D006229:Hand Dermatoses / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007868:Leg Dermatoses / Q000209:etiology / Q000382:microbiology; D008193:Lyme Disease / Q000150:complications* / Q000276:immunology; D010859:Pigmentation Disorders / Q000209:etiology; D012867:Skin / Q000382:microbiology*
chemical_list: D000907:Antibodies, Bacterial