Acrodermatitis chronica atrophicans laboratory findings
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Raviteja Guddeti, M.B.B.S. [3]
Overview
High anti-spirochetal antibody levels (such as IgG, IgM and IgA) has been detected at indirect immunofluorescence and enzyme linked immunosorbent assay (ELISA). Among various antigens in borrelia burgdorferi, flagellum antigen is one of the recommended serologic evaluation in acrodermatitis chronica atrophicans patients. Diagnosis of acrodermatitis chronica atrophicans can be excluded if the serologic evaluataion is negative. Borrelia itself has been found in some of the skin samples. When clinical presentations are not clear enough, biopsy and histological evaluation can assist. Findings such as plasma cells, histiocytes and lymphocytic infiltration plus telangiectasia and thinning of dermis and epidermis are commonly found in skin biopsies.
Laboratory Findings
- Since diagnosis of acrodermatitis chronica atrophicans could be dificult due to various presentations, physicians can use serologic and histologic examination to confirm it.[1][2]
- High anti-spirochetal antibody levels (such as IgG, IgM and IgA) has been detected at indirect immunofluorescence and enzyme linked immunosorbent assay (ELISA).[3][4][1][5]
- Among various antigens in borrelia burgdorferi, flagellum antigen is one of the recommended serologic evaluation in acrodermatitis chronica atrophicans patients. Moreover checking IgG against borrelia are more specific compared to IgM.[4]
- Diagnosis of acrodermatitis chronica atrophicans can be excluded if the serologic evaluataion is negative.[6][7]
- Based on various studied cases there is no relation between anti-spirochetal IgG and inflammatory cell concentration (such as plasma cell concentration).
- Borrelia itself has been found in some of the skin samples. In a study done on 693 patients suffering from acrodermatitis chronica atrophicans, 30.1% of samples were positive for borrelia. [1][8]
- Borrelia can grew in skin culture even after 10 years of active disease, which is an evidence of borrelia ability to survive for a long period.[9]
- Negative skin culture for borrelia doesn’t exclude the diagnosis, however detection of borrelia DNA can certainly confirm the diagnosis.[10][6]
- A study done on patients with acrodermatitis chronica atrophicans revealed rheumatoid factor in 32% of patients.[4]
- Elevated levels of ESR could be seen in these patients.[10]
- Based on a study done on acrodermatitis chronica atrophicans patients, expression of pro-inflammatory cytokines (such as tumor necrosis factor alpha and interleukin-4) have been detected in skin biopsies.[11]
- When clinical presentations are not clear enough, biopsy and histological evaluation can assist.[6]
- Biopsy shows chronic inflammatory signs in chronic cases. Other histological finding are listed below: [12][3][10]
- Perivascular lymphocytic infiltration
- Plasma cells
- Histiocytes
- Telangiectasia
- Pigmented stratum germinativum
- Dermis and epidermis thinning
References
- ↑ 1.0 1.1 1.2 Ogrinc K, Maraspin V, Lusa L, Cerar Kišek T, Ružić-Sabljić E, Strle F (2021). “Acrodermatitis chronica atrophicans: clinical and microbiological characteristics of a cohort of 693 Slovenian patients”. J Intern Med. doi:10.1111/joim.13266. PMID 33550695 Check
|pmid=value (help). - ↑ Muller, Kurt E. (2012). “Damage of Collagen and Elastic Fibres by Borrelia Burgdorferi – Known and New Clinical and Histopathological Aspects”. The Open Neurology Journal. 6 (1): 179–186. doi:10.2174/1874205X01206010179. ISSN 1874-205X.
- ↑ 3.0 3.1 Asbrink E, Hovmark A, Olsson I (1986). “Clinical manifestations of acrodermatitis chronica atrophicans in 50 Swedish patients”. Zentralbl Bakteriol Mikrobiol Hyg A. 263 (1–2): 253–61. doi:10.1016/s0176-6724(86)80128-6. PMID 3577484.
- ↑ 4.0 4.1 4.2 Hansen K, Asbrink E (1989). “Serodiagnosis of erythema migrans and acrodermatitis chronica atrophicans by the Borrelia burgdorferi flagellum enzyme-linked immunosorbent assay”. J Clin Microbiol. 27 (3): 545–51. doi:10.1128/jcm.27.3.545-551.1989. PMC 267355. PMID 2715325.
- ↑ Weber K, Schierz G, Wilske B, Preac-Mursic V (1984). “[Clinical aspects and etiology of acrodermatitis chronica atrophicans]”. Hautarzt. 35 (11): 571–7. PMID 6394553.
- ↑ 6.0 6.1 6.2 “StatPearls”. 2021. PMID 33085436 Check
|pmid=value (help). - ↑ Stanek, G.; Fingerle, V.; Hunfeld, K.-P.; Jaulhac, B.; Kaiser, R.; Krause, A.; Kristoferitsch, W.; O’Connell, S.; Ornstein, K.; Strle, F.; Gray, J. (2011). “Lyme borreliosis: Clinical case definitions for diagnosis and management in Europe”. Clinical Microbiology and Infection. 17 (1): 69–79. doi:10.1111/j.1469-0691.2010.03175.x. ISSN 1198-743X.
- ↑ Rijpkema SG, Tazelaar DJ, Molkenboer MJ, Noordhoek GT, Plantinga G, Schouls LM; et al. (1997). “Detection of Borrelia afzelii, Borrelia burgdorferi sensu stricto, Borrelia garinii and group VS116 by PCR in skin biopsies of patients with erythema migrans and acrodermatitis chronica atrophicans”. Clin Microbiol Infect. 3 (1): 109–116. doi:10.1111/j.1469-0691.1997.tb00259.x. PMID 11864084.
- ↑ Åsbrink, Eva; Hovmark, Anders (2009). “Successful Cultivation of Spirochetes from Skin Lesions of Patients With Erythema Chronicum Migrans Afzelius and Acrodermatitis Chronica Atrophicans”. Acta Pathologica Microbiologica Scandinavica Series B: Microbiology. 93B (1–6): 161–163. doi:10.1111/j.1699-0463.1985.tb02870.x. ISSN 0108-0180.
- ↑ 10.0 10.1 10.2 Nadal, D; Gundelfinger, R; Flueler, U; Boltshauser, E (1988). “Acrodermatitis chronica atrophicans”. Archives of Disease in Childhood. 63 (1): 72–74. doi:10.1136/adc.63.1.72. ISSN 0003-9888.
- ↑ Müllegger RR, McHugh G, Ruthazer R, Binder B, Kerl H, Steere AC (2000). “Differential expression of cytokine mRNA in skin specimens from patients with erythema migrans or acrodermatitis chronica atrophicans”. J Invest Dermatol. 115 (6): 1115–23. doi:10.1046/j.1523-1747.2000.00198.x. PMID 11121150.
- ↑ Rosenlund S, Bækgaard N, Menné T (2011). “[Acrodermatitis chronica atrophicans can be difficult to diagnose]”. Ugeskr. Laeg. (in Danish). 173 (50): 3272–3. PMID 22153213. Unknown parameter
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