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Gordon ER, Adeuyan O, Schreidah CM, Chen C, Trager MH, Lapolla BA, Fahmy LM, Weng C, Geskin LJ. Clusters, crop dusters, and myth busters: a scoping review of environmental exposures and cutaneous T-cell lymphoma. Ital J Dermatol Venerol 2023; 158:467-482. [PMID: 38015484 DOI: 10.23736/s2784-8671.23.07729-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Cutaneous T-cell lymphoma (CTCL) is a heterogenous group of non-Hodgkin lymphomas. Similar presentation to benign conditions, significant genetic variation, and lack of definitive biomarkers contributes to diagnostic delay. The etiology of CTCL is unknown, and environmental exposures, such as geographic, occupational, chemicals, sunlight, and insects have been investigated. EVIDENCE ACQUISITION Review of the literature for CTCL and exposures was performed in PubMed and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews. This search yielded 193 total results, which were initially screened with defined inclusion and exclusion criteria. The 45 remaining articles were reviewed and classified by exposure type. EVIDENCE SYNTHESIS The most frequently investigated CTCL exposure type was geographic (13/45 articles, 29%). Chemical exposures were commonly discussed (10/45 articles, 22%), along with occupational (10/45 articles, 22%). Insect exposures (6/45, 13%) and sun exposure (3/45, 7%) were also reviewed, along with articles describing multiple exposure types (3/45, 7%). Article types ranged from cases to systematic reviews and case-control studies. Evidence linking CTCL and these exposures was mixed. Limitations of this investigation include reliance on patient reporting and frequent speculation on disease association versus causality. CONCLUSIONS This investigation synthesizes the current literature on exposures potentially implicated in the pathogenesis of CTCL, while offering guidance on patient history-taking to ensure potential exposures are captured. Awareness of these possible associations may improve understanding of disease pathogenesis and diagnosis. Moreover, these insights may help with public health decision-making and disease mitigation.
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Affiliation(s)
- Emily R Gordon
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Oluwaseyi Adeuyan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Celine M Schreidah
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Caroline Chen
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Megan H Trager
- Department of Dermatology, Irving Medical Center, Columbia University, New York, NY, USA
| | - Brigit A Lapolla
- Department of Dermatology, Irving Medical Center, Columbia University, New York, NY, USA
| | - Lauren M Fahmy
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Irving Medical Center, Columbia University, New York, NY, USA
| | - Larisa J Geskin
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA -
- Department of Dermatology, Irving Medical Center, Columbia University, New York, NY, USA
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Rao M, Young K, Jackson-Cowan L, Kourosh A, Theodosakis N. Post-Inflammatory Hypopigmentation: Review of the Etiology, Clinical Manifestations, and Treatment Options. J Clin Med 2023; 12:jcm12031243. [PMID: 36769891 PMCID: PMC9917556 DOI: 10.3390/jcm12031243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual's health-related quality of life and may result in stigma. Although most cases of post-inflammatory hypopigmentation resolve spontaneously over time, a systematic diagnostic approach can help with identifying the underlying etiology and informing treatment strategies. It can be due to cutaneous inflammation, sequelae of inflammatory or infectious dermatoses, or dermatologic procedures. Therefore, a thorough understanding of the epidemiology, patient history, physical exam findings, and clinical features of post-inflammatory hypopigmentation phenomenon can explain the primary cause to providers and allow for patient education. It is also important to understand the various therapeutic approaches available and the efficacy of these options, which will inform providers to choose the appropriate therapy for patients. Although algorithms exist for classifying acquired disorders of hypopigmentation, there are no established algorithms for the diagnosis and treatment of post-inflammatory hypopigmentation, which warrants further exploration and discourse.
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Affiliation(s)
- Medha Rao
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | | | - Ladonya Jackson-Cowan
- The Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Arianne Kourosh
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nicholas Theodosakis
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence: ; Tel.: +617-724-2919
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Kolm I, Buset C, Flury U, Nosek D, Kazakov DV, Kempf W. Lichen aureus with pseudolymphomatous infiltrate. J Cutan Pathol 2021; 48:669-673. [PMID: 33368548 DOI: 10.1111/cup.13948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/16/2022]
Abstract
Lichen aureus is a variant of pigmented purpuric dermatoses. The usual histopathology of lichen aureus is characterized by a subepidermal dense, band-like lymphocytic infiltrate, extravasated erythrocytes, and hemosiderin deposits. We report three patients with lichen aureus on the extremities with similar clinical, dermoscopic, and histopathological findings characterized by a dense band-like relatively deep dermal infiltrate accompanied by extravasation of erythrocytes and hemosiderin deposits occasioning a resemblance to a lymphoproliferative disorder.
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Affiliation(s)
- Isabel Kolm
- Department of Dermatology, University Hospital Zurich, Switzerland
| | - Caroline Buset
- Department of Dermatology, University Hospital Zurich, Switzerland.,Dermatology Service, Cantonal Hospital Frauenfeld, Switzerland
| | - Ursula Flury
- Division of Dermatology, Lucerne Cantonal Hospital and Cancer Center, Lucerne, Switzerland
| | - Daniel Nosek
- Department of Medical Biosciences/Pathology, Umeå University, Umeå, Sweden
| | - Dmitry V Kazakov
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Werner Kempf
- Department of Dermatology, University Hospital Zurich, Switzerland.,Kempf & Pfaltz Histologische Diagnostik, Zurich, Switzerland
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Travaglino A, Varricchio S, Pace M, Russo D, Picardi M, Baldo A, Staibano S, Mascolo M. Borrelia burgdorferi
in primär kutanen Lymphomen: eine systematische Übersicht und Metaanalyse. J Dtsch Dermatol Ges 2020; 18:1379-1386. [PMID: 33373156 DOI: 10.1111/ddg.14289_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Travaglino
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Silvia Varricchio
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mirella Pace
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Daniela Russo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Marco Picardi
- Hematology Section, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Antonello Baldo
- Dermatology Section, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Stefania Staibano
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Massimo Mascolo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Travaglino A, Varricchio S, Pace M, Russo D, Picardi M, Baldo A, Staibano S, Mascolo M. Borrelia burgdorferi in primary cutaneous lymphomas: a systematic review and meta-analysis. J Dtsch Dermatol Ges 2020; 18:1379-1384. [PMID: 33029842 DOI: 10.1111/ddg.14289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The association between Borrelia burgdorferi and primary cutaneous lymphoma is still unclear. This systematic review and meta-analysis aims to define the association of Borrelia burgdorferi with primary cutaneous lymphoma and its different entities. METHODS Electronic databases were searched for all studies that assessed the presence of Borrelia burgdorferi DNA in specimens of primary cutaneous lymphoma. The association between Borrelia and primary cutaneous lymphomas was assessed with an odds ratio (significant p < 0.05); cutaneous specimens with no lymphoproliferative disorders were used as controls. A secondary analysis was performed to assess the prevalence of Borrelia infection in different lymphoma entities. RESULTS Ten studies with 506 primary cutaneous lymphomas and 201 controls were included. The prevalence of Borrelia DNA positivity was highly heterogeneous among studies from different regions. Borrelia DNA positivity was significantly associated with primary cutaneous lymphomas (odds ratio = 10.88; p < 0.00001). The prevalence of Borrelia DNA positivity was similar among different entities (marginal zone: 7.3 %; follicular: 8.1 %; diffuse large B-cell: 7.5 %; mycosis fungoides: 8 %). CONCLUSIONS Borrelia burgdorferi is significantly associated with primary cutaneous lymphomas, with no differences among the several lymphoma entities (both B-cell and T-cell), but with strong geographical differences. Molecular testing for Borrelia would be justified in patients with primary cutaneous lymphoma from endemic areas.
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Affiliation(s)
- Antonio Travaglino
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Silvia Varricchio
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mirella Pace
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Daniela Russo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Marco Picardi
- Hematology Section, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Antonello Baldo
- Dermatology Section, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Stefania Staibano
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Massimo Mascolo
- Pathology Section, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics (Basel) 2019; 8:antibiotics8040269. [PMID: 31888310 PMCID: PMC6963229 DOI: 10.3390/antibiotics8040269] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Objective: Chronic Lyme disease has been a poorly defined term and often dismissed as a fictitious entity. In this paper, the International Lyme and Associated Diseases Society (ILADS) provides its evidence-based definition of chronic Lyme disease. Definition: ILADS defines chronic Lyme disease (CLD) as a multisystem illness with a wide range of symptoms and/or signs that are either continuously or intermittently present for a minimum of six months. The illness is the result of an active and ongoing infection by any of several pathogenic members of the Borrelia burgdorferi sensu lato complex (Bbsl). The infection has variable latency periods and signs and symptoms may wax, wane and migrate. CLD has two subcategories, CLD, untreated (CLD-U) and CLD, previously treated (CLD-PT). The latter requires that CLD manifestations persist or recur following treatment and are present continuously or in a relapsing/remitting pattern for a duration of six months or more. Methods: Systematic review of over 250 peer reviewed papers in the international literature to characterize the clinical spectrum of CLD-U and CLD-PT. Conclusion: This evidence-based definition of chronic Lyme disease clarifies the term's meaning and the literature review validates that chronic and ongoing Bbsl infections can result in chronic disease. Use of this CLD definition will promote a better understanding of the infection and facilitate future research of this infection.
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A Reactive Peripheral Gamma-Delta T-cell Lymphoid Proliferation After a Tick Bite. Am J Dermatopathol 2019; 41:e73-e75. [DOI: 10.1097/dad.0000000000001352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hellmich L. [31/f with livid erythematous papules and nodules : Preparation for the specialist examination: part 6]. Hautarzt 2018; 69:100-104. [PMID: 30374538 DOI: 10.1007/s00105-018-4240-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Luisa Hellmich
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Acrodermatitis chronica atrophicans: various faces of the late form of Lyme borreliosis. Postepy Dermatol Alergol 2018; 35:490-494. [PMID: 30429707 PMCID: PMC6232541 DOI: 10.5114/ada.2018.77240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/17/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Acrodermatitis chronica atrophicans (ACA) is probably the most common late and chronic manifestation of the Lyme borreliosis seen in European patients. Aim To analyze epidemiological data, and to investigate the effects of treatment of patients with ACA. Material and methods Nine patients were included in the study. All patients had serological examinations (ELISA and Western blot) and histopathological examination of the skin lesions performed. Eight patients had PCR in the skin biopsy performed. Results The duration of symptoms ranged from 2 months to 2 years. In 7 patients, skin lesions were located on lower limbs, in 2 patients - in a non-typical body area - abdomen. In 1 patient, scleroderma and in 3 patients, diabetes mellitus was diagnosed. Borrelia burgdorferi DNA was detected in 25% of the skin biopsy specimens. IgG anti-B. burgdorferi specific antibodies were present in serum of all patients (confirmed by Western blot). In all cases, the diagnosis was confirmed by histopathological examination. The response to ceftriaxone therapy varied. In 5 cases, the lesions resolved completely, in others they faded. Conclusions Despite raising awareness of Lyme borreliosis, late forms of the disease such as ACA are still observed. Acrodermatitis chronica atrophicans skin lesions may be located in non-characteristic areas, e.g. abdominal skin. Symptoms are not irritating or painful, therefore patients do not seek medical help. The effect of antibiotic treatment varies.
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Comfere N, Sundram U, Hurley MY, Swick B. Views of dermatopathologists about clonality assays in the diagnosis of cutaneous T-cell and B-cell lymphoproliferative disorders. J Cutan Pathol 2017; 45:39-47. [DOI: 10.1111/cup.13072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/01/2017] [Accepted: 10/26/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Nneka Comfere
- Department of Dermatology and Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Uma Sundram
- Department of Pathology; Oakland University William Beaumont School of Medicine and Beaumont Health Systems; Royal Oak Michigan
| | | | - Brian Swick
- Department of Dermatology; University of Iowa; Iowa City Iowa
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Bauvin O, Schmutz JL, De Martino S, Busato T, Cribier B, Barbaud A, Wahl D, Bursztejn AC. A foot tumour as late cutaneous Lyme borreliosis: a new entity? Br J Dermatol 2017; 177:1127-1130. [PMID: 28477365 DOI: 10.1111/bjd.15633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
Acrodermatitis chronica atrophicans (ACA) is the late cutaneous form of Lyme borreliosis. The early inflammatory phase manifests with a bluish-red discoloration and doughy swelling of the skin. The atrophic phase represents a late-phase process with red discoloration, and a thin and wrinkled appearance of the skin. We present a patient who exhibited a previously undescribed form of late cutaneous Lyme borreliosis (LCLB) with a foot tumour. A 64-year-old woman had a large tumorous lesion on the right sole. The tumour size and deformation of the feet made wearing shoes difficult. On skin histology, a granulomatous lymphohistiocytic infiltrate with plasma cells was noticed. In fact, the patient recalled tick bites 2 or 3 years before. Borrelia burgdorferi (Bb) serology was highly positive and a polymerase chain reaction analysis on the skin biopsy detected Bb sensu lato, genospecies B. afzelii. We diagnosed LCLB and antibiotics were prescribed. On the more recent examination, the tumour had totally disappeared; the skin was atrophic and dry with only few scales. We report an atypical case of European LCLB, suggesting that ACA is not the only possible presentation of LCLB. The diagnosis of ACA is often clinically missed for months or years, and may be mistaken at the inflammation phase for vascular disorders, erysipelas or bursitis/arthritis, and at the atrophic phase for lichen sclerosus atrophicus, morphoea or anetoderma. To our knowledge, no such tumorous LCLB has previously been described.
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Affiliation(s)
- O Bauvin
- Dermatology Department, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - J-L Schmutz
- Dermatology Department, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - S De Martino
- National Borrelia Reference Centre, Strasbourg University Hospital, Strasbourg, France
| | - T Busato
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular And Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - B Cribier
- Dermatology Department, Strasbourg University Hospital, Strasbourg, France
| | - A Barbaud
- Dermatology Department, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - D Wahl
- Vascular Medicine Division and Regional Competence Centre for Rare Vascular And Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - A-C Bursztejn
- Dermatology Department, Nancy University Hospital, Vandoeuvre-les-Nancy, France
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Abstract
INTRODUCTION Current laboratory testing of Lyme borreliosis mostly relies on serological methods with known limitations. Diagnostic modalities enabling direct detection of pathogen at the onset of the clinical signs could overcome some of the limitations. Molecular methods detecting borrelial DNA seem to be the ideal solution, although there are some aspects that need to be considered. Areas covered: This review represent summary and discussion of the published data obtained from literature searches from PubMed and The National Library of Medicine (USA) together with our own experience on molecular diagnosis of Lyme disease. Expert commentary: Molecular methods are promising and currently serve as supporting diagnostic testing in Lyme borreliosis. Since the field of molecular diagnostics is under rapid development, molecular testing could become an important diagnostic modality.
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Affiliation(s)
- Eva Ružić-Sabljić
- a Institute of Microbiology ansd Immunology, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia
| | - Tjaša Cerar
- a Institute of Microbiology ansd Immunology, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia
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Cutaneous Small/Medium CD4+ Pleomorphic T-Cell Lymphoma-Like Nodule in a Patient With Erythema Chronicum Migrans. Am J Dermatopathol 2016; 38:448-52. [PMID: 27097344 DOI: 10.1097/dad.0000000000000596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CD4+ small/medium pleomorphic T-cell lymphoma is a relatively rare subtype of cutaneous lymphoproliferative disorder with an indolent clinical behavior. The place of this condition among lymphomas is debatable. The authors describe a rare case of the direct association of CD4 small/medium pleomorphic T-cell lymphoma-like solitary nodule with Borrelia burgdorferi infection in a 5-year-old boy, discuss the reactive nature of this condition, and emphasize the importance of clinicopathological correlation.
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Brandt FC, Ertas B, Falk TM, Metze D, Böer-Auer A. Histopathology and immunophenotype of acrodermatitis chronica atrophicans correlated withospAandospCgenotypes ofBorreliaspecies. J Cutan Pathol 2015; 42:674-92. [DOI: 10.1111/cup.12550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/04/2015] [Accepted: 07/04/2015] [Indexed: 02/02/2023]
Affiliation(s)
| | | | | | - Dieter Metze
- Department of Dermatology; Munster University; Münster Germany
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