Werner Kempf1, Dmitry V Kazakov2, Eugen Hübscher3, Oliver Gugerli4, Andreas W Gerbig5, Regula Schmid6, Gabriele Palmedo7, Heinz Kutzner7. 1. Kempf und Pfaltz, Histologische Diagnostik, Zürich, Switzerland. Electronic address: werner.kempf@kempf-pfaltz.ch. 2. Kempf und Pfaltz, Histologische Diagnostik, Zürich, Switzerland; Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic. 3. private practice, Biel, Switzerland. 4. Dermatopathology Viollier SA, Lausanne, Switzerland. 5. private practice, Koeniz, Switzerland. 6. Private practice, Baden, Switzerland. 7. Dermatopathologie Friedrichshafen, Friedrichshafen, Germany.
Abstract
BACKGROUND: With the exception of erythema migrans, Borrelia infection of the skin manifests much more commonly with B cell-rich infiltrates. T cell-rich lesions have rarely been described. OBJECTIVE: We report a series of 6 patients with cutaneous borreliosis presenting with T cell-predominant skin infiltrates. METHODS: We studied the clinicopathologic and molecular features of 6 patients with T cell-rich skin infiltrates. RESULTS: Half of the patients had erythematous patchy, partly annular lesions, and the other patients had features of acrodermatitis chronica atrophicans. Histopathology revealed a dense, band-like or diffuse dermal infiltrate. Apart from small, well differentiated lymphocytes, there were medium-sized lymphocytes with slight nuclear atypia and focal epidermotropism. An interstitial histiocytic component was found in 4 cases, including histiocytic pseudorosettes. Fibrosis was present in all cases but varied in severity and distribution. In 5 patients, borrelia DNA was detected in lesional tissue using polymerase chain reaction studies. No monoclonal rearrangement of T-cell receptor gamma genes was found. LIMITATIONS: This retrospective study was limited by the small number of patients. CONCLUSION: In addition to unusual clinical presentation, cutaneous borreliosis can histopathologically manifest with a T cell-rich infiltrate mimicking cutaneous T-cell lymphoma. Awareness of this clinicopathologic constellation is important to prevent underrecognition of this rare and unusual presentation representing a Borrelia-associated T-cell pseudolymphoma.
BACKGROUND: With the exception of erythema migrans, Borrelia infection of the skin manifests much more commonly with B cell-rich infiltrates. T cell-rich lesions have rarely been described. OBJECTIVE: We report a series of 6 patients with cutaneous borreliosis presenting with T cell-predominant skin infiltrates. METHODS: We studied the clinicopathologic and molecular features of 6 patients with T cell-rich skin infiltrates. RESULTS: Half of the patients had erythematous patchy, partly annular lesions, and the other patients had features of acrodermatitis chronica atrophicans. Histopathology revealed a dense, band-like or diffuse dermal infiltrate. Apart from small, well differentiated lymphocytes, there were medium-sized lymphocytes with slight nuclear atypia and focal epidermotropism. An interstitial histiocytic component was found in 4 cases, including histiocytic pseudorosettes. Fibrosis was present in all cases but varied in severity and distribution. In 5 patients, borrelia DNA was detected in lesional tissue using polymerase chain reaction studies. No monoclonal rearrangement of T-cell receptor gamma genes was found. LIMITATIONS: This retrospective study was limited by the small number of patients. CONCLUSION: In addition to unusual clinical presentation, cutaneous borreliosis can histopathologically manifest with a T cell-rich infiltrate mimicking cutaneous T-cell lymphoma. Awareness of this clinicopathologic constellation is important to prevent underrecognition of this rare and unusual presentation representing a Borrelia-associated T-cell pseudolymphoma.
Authors: Samuel Shor; Christine Green; Beatrice Szantyr; Steven Phillips; Kenneth Liegner; Joseph Jr Burrascano; Robert Bransfield; Elizabeth L Maloney Journal: Antibiotics (Basel) Date: 2019-12-16