title: "Borrelia-associated early-onset morphea": a particular type of scleroderma in childhood and adolescence with high titer antinuclear antibodies? Results of a cohort analysis and presentation of three cases.
abstract: BACKGROUND
  Morphea is an inflammatory autoimmune skin sclerosis of unknown etiology. A causative role of Borrelia burgdorferi infection has been controversially discussed, but no conclusive solution has yet been achieved.
  
  
  OBJECTIVE
  Intrigued by 3 young patients with severe Borrelia-associated morphea and high-titer antinuclear antibodies, we retrospectively examined the relationship between Borrelia exposure, serologic autoimmune phenomena and age at disease onset in morphea patients.
  
  
  METHODS
  In 90 morphea patients the presence of Borrelia-specific serum antibodies was correlated to the age at disease onset and the presence and titers of antinuclear antibodies. Patients with active Borrelia infection or high-titer antinuclear antibodies due to systemic sclerosis or lupus erythematosus served as controls.
  
  
  RESULTS
  We observed a statistically highly significant association between morphea, serologic evidence of Borrelia infection, and high-titer antinuclear antibodies when disease onset was in childhood or adolescence.
  
  
  CONCLUSIONS
  Because pathogenic Borrelia species may vary in different geographic regions the relevance of Borrelia infection in morphea induction may show regional variations.
  
  
  CONCLUSIONS
  B burgdorferi infection may be relevant for the induction of a distinct autoimmune type of scleroderma; it may be called "Borrelia-associated early onset morphea" and is characterized by the combination of disease onset at younger age, infection with B burgdorferi, and evident autoimmune phenomena as reflected by high-titer antinuclear antibodies. As exemplified by the case reports, it may take a particularly severe course and require treatment of both infection and skin inflammation.
authors.affiliation: Department of Dermatology, University of Munich, Munich, Germany. joerg.prinz@med.uni-muenchen.de
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Prinz
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Kutasi
authors.forename: Peter
authors.initials: P
authors.lastname: Weisenseel
authors.forename: László
authors.initials: L
authors.lastname: Pótó
authors.forename: Zita
authors.initials: Z
authors.lastname: Battyáni
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruzicka
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000097:blood*; D000907:Antibodies, Bacterial / Q000097:blood; D000918:Antibody Specificity; D025065:Borrelia burgdorferi; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008193:Lyme Disease / Q000150:complications* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012594:Scleroderma, Localized / Q000276:immunology* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M