A painless erythematous swelling of the external ear as a manifestation of Lyme disease: a case report

Abstract

Background Lyme disease is the most common tick-borne illness in the USA, Canada, and Europe. Clinical manifestations vary greatly, with localized skin findings functioning as early signs of the disease, followed by disseminated disease. The rarest dermatologic presentation of Lyme is a borrelial lymphocytoma, occurring distinctly in Europe and caused typically by Borrelia afzelii. Case presentation We report a case of a Caucasian 5-year-old European-American boy with slowly progressing, painless edema and erythema of his right pinna. Travel history revealed significant exposure to ticks during a recent trip to Eastern Europe. Laboratory testing for Borrelia burgdorferi demonstrated mixed positivity. He was treated with a 21-day course of amoxicillin, with complete resolution of symptoms and no sign of secondary Lyme disease. Conclusions Borrelial lymphocytoma is a rare manifestation of Lyme disease in North America, although not uncommon in Europe. Diagnosis is made by the presence of a painless erythematous swelling typically found on the ear lobe, nipples, or testes. Laboratory tests are available but with low sensitivity, therefore, a high index of suspicion is necessary for a clinical diagnosis to be made. Treatment for isolated borrelial lymphocytoma is doxycycline 4 mg/kg up to 100 mg twice daily, whereas for children less than 8 years of age amoxicillin 50 mg/kg divided three times daily, for 3–4 weeks, is preferred.

A scrotum plaque in a 5‐year‐old boy

“…BL is a subacute reaction that typically appears one to two months after the initial inoculation, frequently preceded or accompanied by EM 1,7,9 . Our case was particularly challenging, due to the unusually long latency period and the absence of EM 6,10 . Clinically, BLs are soft, non‐tender, bluish red, sharply demarcated, nodules or plaques, usually solitary and without accompanying extracutaneous signs or symptoms 6,7 …”

“…Lyme disease evolves in stages and EM represents an early presentation, appearing in the first weeks after inoculation, at the tick bite site. After that, hematogenous dissemination and host‐driven immune reactions are responsible for other manifestations, such as BL in an early stage and ACA in a late phase 1,6‐8 …”

“…bissettii have also been reported 1 . For this reason, BL is a skin manifestation almost exclusively observed in Europe 1,6‐8 . BL is a subacute reaction that typically appears one to two months after the initial inoculation, frequently preceded or accompanied by EM 1,7,9 .…”

Актуальні Питання Хвороби Лайма У Дітей

“…Бореліозний артрит і кардит частіше трапляються в США, тоді як неврологічні й пізні шкірні прояви частіше виявляють в Європі [47][48][49]. Діти частіше, ніж дорослі, мають лімфоцитоми (котрі виникають на вусі або соску) [50].…”

“…Попередні дослідження лікування дорослих із лайм-менінгітом повідомляли про ускладнення лікування. У 2 рандомізованих контрольованих дослідженнях дорослих із лаймським менінгітом, що порівнювали цефтріаксон з доксицикліном, у 4 із 77 дорослих, рандомізованих на лікування цефтріаксоном (5 %), було побічних явищ, що призвели до припинення цієї терапії [50]. Як відомо, лікування паралічу обличчя займає більше часу, але в іншому випадку тип або тривалість симптомів до лікування не мали статистично значущого впливу на результат.…”