ABSTRACT
BACKGROUND: Clinical manifestations of Lyme disease are mainly cutaneous, neurologic, cardiac and/or located joints. Some dermatologic manifestations are more specific. CASE REPORT: An eight year-old-girl was examined because she suffered from a nodular lesion located on the left breast areola which appeared 3 months earlier. This lesion was associated with an expanding erythematous annular lesion located on the anterior face of thorax and left axillary area, without any lymphadenopathy. The association of this cutaneous lymphocytoma and erythema chronicum migrans was suggestive of Borellia infection despite absence of previous tick bite. Serologic tests (indirect immunofluorescence) were negative, but both lesions disappeared within 2 weeks with ceftriaxone, 50 mg/kg/day. CONCLUSIONS: This association is pathognomonic of Lyme disease; serologic tests may be found negative in the early stages of disease.
Subject(s)
Breast Neoplasms/complications , Erythema Chronicum Migrans/complications , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Lyme Disease/diagnosis , Nipples , Skin Neoplasms/complications , Breast , Breast Neoplasms/drug therapy , Ceftriaxone/therapeutic use , Child , Erythema Chronicum Migrans/drug therapy , Female , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Skin Neoplasms/drug therapyABSTRACT
Thalidomide is effective in the treatment of such disabling dermatologic diseases as aphthosis, discoid lupus erythematosus, and prurigo nodularis, in which other drugs fail. However, its use can induce neuropathy necessitating caution in its administration. It was found in this electrophysiologic study of 13 patients that the data best revealing neuropathy, even when clinical abnormalities were not apparent, were reduction of sensory nerve action potential amplitude on the sural nerve, increase of somatosensory evoked potential latency following sural nerve stimulation, and reduction of sensory action potential amplitude on stimulating the median nerve at the wrist. In two patients, electrophysiologic abnormalities had increased after withdrawal, suggesting a prolonged action of thalidomide. Timely reduction of dosage, after detection of changes indicating the onset of side effects, could reduce the risk of the sometimes rapid emergence of clinical symptoms.
