ABSTRACT
BACKGROUND: Borrelial infection is characterized by various skin manifestations that are usually classified into three main types: chronic migratory erythema, borrelial lymphocytoma and acrodermatitis chronica atrophicans. We report an unusual case of borrelial cutaneous infection presenting as a mediofacial erythema that cannot be included in any of these three categories. CASE REPORT: A 51-year-old woman presented with infiltrated erythema of the middle of the face extending to the neck and chin. Medical history and physical examination revealed no signs of rosaceae. Infection with Borrelia was suspected on skin biopsy examination, which showed an inflammatory dermal infiltrate containing numerous plasma cells. The diagnosis of B.afzelii infection was confirmed by serology and polymerase chain reaction on the skin biopsy, both of which were positive for B.afzelii. DISCUSSION: Borrelial erythema of the face may represent a special form of cutaneous borrelial infection, which must be considered in the differential diagnosis of facial erythema, especially in areas of endemic borreliosis.
Subject(s)
Borrelia burgdorferi Group , Erythema Chronicum Migrans , Facial Dermatoses/diagnosis , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Biopsy , Borrelia burgdorferi Group/genetics , Borrelia burgdorferi Group/immunology , Diagnosis, Differential , Doxycycline/administration & dosage , Doxycycline/therapeutic use , Erythema Chronicum Migrans/diagnosis , Erythema Chronicum Migrans/drug therapy , Erythema Chronicum Migrans/pathology , Facial Dermatoses/drug therapy , Female , Follow-Up Studies , Humans , Immunoblotting , Middle Aged , Polymerase Chain Reaction , Skin/pathology , Time Factors , Treatment OutcomeSubject(s)
Lupus Erythematosus, Discoid , Antirheumatic Agents/administration & dosage , Antirheumatic Agents/therapeutic use , Biopsy , Chloroquine/administration & dosage , Chloroquine/therapeutic use , Diagnosis, Differential , Female , Humans , Lupus Erythematosus, Discoid/diagnosis , Lupus Erythematosus, Discoid/drug therapy , Lupus Erythematosus, Discoid/pathology , Magnetic Resonance Imaging , Middle Aged , Skin/pathology , Time FactorsSubject(s)
Air Bags/adverse effects , Facial Injuries/etiology , Facial Injuries/pathology , Accidents, Traffic , Adult , Dermatitis/etiology , Female , HumansABSTRACT
INTRODUCTION: We report the case of a Pseudomonas (P.) aeruginosa eccrine hidradenitis in a child, or a "Pseudomonas Hot Foot Syndrome", revealing an acute lymphoblastic leukemia. OBSERVATION: A 10 year-old girl consulted for the sudden onset of painful and necrotic palmoplantar nodules in a context of fever and shivering. Histology of a cutaneous biopsy found necrosis of the eccrine glands and, on culture, P. aeruginosa. The blood count revealed pancytopenia and the myelogram acute lymphoblastic leukemia. All the hemocultures and other microbiological samples were negative. The cutaneous signs had appeared 48 hours after bathing in an aquatic amusement park. Diagnosis of Pseudomonas eccrine hidradenitis, or "Pseudomonas Hot Foot Syndrome" was retained, although the local sanitary authorities were not able to demonstrate P. aeruginosa contamination of the water in the park. COMMENTS: Lesions evoking juvenile Pseudomonas aeruginosa eccrine hidradenitis without obvious traumatic factor must lead to the search for P. aeruginosa contamination from water and the subsequent sanitary and epidemiological consequences. Furthermore, severe P. aeruginosa cutaneous infections in children must also lead to the search for an underlying immunosuppression and notably an acute leukemic process.
