Mini Erythema Migrans – A Sign of Early Lyme Borreliosis

Abstract

Background: An erythema migrans (EM) remaining smaller than 5 cm in diameter, called mini EM by us, has not been addressed in detail. Objective: To study the significance of the mini EM as a sign of Lyme borreliosis. Methods: Patients with suspected mini EM were retrospectively selected out of 257 consecutive patients with EM. The diagnosis of mini EM rested on the cultivation of Borrelia burgdorferi. Species and subtype analysis of culture isolates was performed using outer surface protein A (OspA) polymerase chain reaction followed by restriction fragment length polymorphism and sequencing of the OspA gene. Results: There was one patient with definite (0.4%) and another patient with a questionable mini EM. Borrelia garinii OspA type 6 was identified in the patient with the definite and B. burgdorferi sensulato in the patient with the questionable mini EM. Conclusion: The mini EM represents an important and apparently uncommon sign of early Lyme borreliosis.

<i>Borrelia burgdorferi</i>-Associated Primary Cutaneous Marginal-Zone B-Cell Lymphoma: A Case Report

“…The spirochete Borrelia burgdorferi has been identified as the aetiological agent of Lyme disease and of several skin manifestations of that, including erythema chronicum migrans, lymphocytoma cutis and acrodermatitis chronica atrophicans [1,2,3,4,5]. An association between B. burgdorferi with primary cutaneous B-cell lymphoma (PCBCL) has long been suspected but just recently, thanks to a polymerase chain reaction (PCR) technique, it had been possible to demonstrate B. burgdorferi- specific DNA in skin lesions of patients with different primary cutaneous B-cell lymphoma subtypes [6,7,8,9,10].…”

Borréliose de Lyme chez l’enfant : étude rétrospective de 16 cas

“…Nous préférons ces critères qui nous permettent d'inclure les « mini érythèmes migrants » [9], déjà rapportés en Europe et surtout les cas diagnostiqués précocement, avant que l'érythème migrant ait atteint un diamètre de 5 cm ou plus. En Alsace, zone d'endémie, la maladie est bien connue et elle est souvent diagnostiquée très tôt.…”

Early Lyme Borreliosis

“…Nevertheless, atypical EM lesions with a persistent small size occur in 1% to 3% of European patients (M€ ullegger, 2001). The term "mini(ature size) EM" has been coined for these lesions (Weber and Wilske, 2006), which are preferentially located on the lower extremities. For these to be recognized as EM, microbiologic confirmation of the presence of B. burgdorferi sensu lato or its DNA from the erythema should be obtained.…”