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Rheumatic manifestations related to acrodermatitis chronica atrophicans. A review of four cases.

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Abstract

BACKGROUND:

Acrodermatitis chronica atrophicans is a delayed manifestation of
Lyme disease caused by a Borrelia burgdorferi subspecies, B. afzelii. Although rheumatic manifestations are rare, they can result in deformities of the fingers and toes if they are not treated promptly.

METHODS:

We report four cases of acrodermatitis chronica atrophicans seen over a 15-year period.

RESULTS:

Two patients had a noninflammatory unilateral knee effusion and one had swelling of the dorsum of one hand. Antimicrobial therapy was followed by a full recovery in the three patients who received an early diagnosis. The remaining patient, a 63-year-old woman, had swelling and dysesthesia in the fingers of both hands. She developed finger deformities over a period of two years. Although the swelling resolved under antimicrobial therapy, she had persistent reducible deformities of the fingers consistent with Jaccoud’s arthropathy.

CONCLUSION:

The diagnosis of acrodermatitis chronica atrophicans rests on a history of a tick bite, a suggestive skin biopsy histology and a positive Western blot for B. afzelii. A positive response to antimicrobial therapy is also required. Acrodermatitis chronica atrophicans, a common condition in central and northern Europe, can cause joint manifestations and persistent finger deformities in the absence of early treatment.

Rev Rhum Engl Ed. 1998 Oct;65(10):567-70.

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