title: Oculopalpebral borreliosis as an unusual manifestation of Lyme disease.
abstract: OBJECTIVE
  To report the case of acrodermatitis chronica atrophicans as an ocularpalpebral manifestation of Lyme borreliosis, with peripheral keratopathy and associated vasculitis.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 16-year-old girl, with a 4-year history of recurrent left eye photophobia, intense redness, and superior eyelid edema, presented with lid erythema, ptosis, superficial venous tortuosity, conjunctival hyperemia, corneal thinning with precipitates, and vascularization. Borrelia burgdorferi was confirmed by immunoblotting. Treatments with doxycycline followed by ceftriaxone were only partially effective. Eyelid biopsy revealed spirochetes and vasculitis with deposition of immunoglobulin G. Oral cefuroxime for 28 days was ineffective. Due to the vasculitis, immunosuppression with azathioprine and topical cyclosporine were given for 4 months. Since then she has been free of flare-ups.
  
  
  CONCLUSIONS
  Lyme borreliosis should be considered in patients with recurrent chronic lid edema and associated keratopathy.
authors.affiliation: Institute of Applied Bio-Ophthalmology, University of Valladolid, Valladolid, Spain.
authors.forename: Giovana
authors.initials: G
authors.lastname: Murillo
authors.forename: Beatriz
authors.initials: B
authors.lastname: Ramírez
authors.forename: L Angel
authors.initials: LA
authors.lastname: Romo
authors.forename: Agustín
authors.initials: A
authors.lastname: Muñoz-Sanz
authors.forename: Denise
authors.initials: D
authors.lastname: Hileeto
authors.forename: Margarita
authors.initials: M
authors.lastname: Calonge
mesh_terms: D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood; D001379:Azathioprine / Q000627:therapeutic use; D025065:Borrelia burgdorferi / Q000276:immunology / Q000302:isolation & purification*; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008193:Lyme Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014657:Vasculitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine