Nakashima T, Maeda M, Hayashi T, Kitamura K
Department of Dermatology, Kumiai Hospital, Takayama, Japan.
J Dermatol. 1999 Dec;26(12):821-4. doi: 10.1111/j.1346-8138.1999.tb02100.x.
A 69-year-old male had noticed pruritus on the back for the previous 3-4 years and cutaneous sclerosis with swelling of the dorsum of the neck had developed in the last one and a half years. However, he had never complained of Raynaud's phenomenon of the fingers, dry mouth, or dry eyes. At this first visit to our hospital, he complained of erythematous cutaneous sclerosis with swelling of the dorsum of the neck. Histopathological findings biopsied from the neck showed epidermal hyperplasia with elongation of rete ridges and homogeneous and fibromatous changes of the dermis with dense perivascular cell infiltration consisting of mononuclear cells or lymphocytes with several nests of incontinentia pigmenti. However, there were no sclerotic changes in blood vessels in the upper dermis biopsied from the forearm skin, although slightly homogeneous and fibromatous changes of the dermis were seen. In the clinical course, the cutaneous sclerotic change enlarged to extend to the bottom of the cheek, forearm, and lower legs. These clinical features and histopathological findings led to the diagnosis of generalized morphea. Hematologic examination showed positive anti-Borrelia burgdorferi IgM antibodies, although there were no positive anti-Borrelia burgdorferi IgG antibodies. These results revealed that there can be a close association of localized scleroderma with Borrelia burgdorferi and that generalized morphea may also represent a Borrelia infection.
一名69岁男性在过去3至4年里注意到背部瘙痒，在过去一年半中出现颈部皮肤硬化并伴有颈部肿胀。然而，他从未有过手指雷诺现象、口干或眼干的症状。在首次就诊我院时，他主诉颈部肿胀伴红斑性皮肤硬化。从颈部活检的组织病理学结果显示表皮增生伴 rete 嵴延长，真皮出现均质化和纤维瘤样改变，伴有由单核细胞或淋巴细胞组成的密集血管周围细胞浸润以及数个色素失禁巢。然而，从前臂皮肤活检的真皮上层血管未见硬化改变，尽管可见真皮轻度均质化和纤维瘤样改变。在临床过程中，皮肤硬化改变扩大至脸颊下部、前臂和小腿。这些临床特征和组织病理学结果导致诊断为泛发性硬斑病。血液学检查显示抗伯氏疏螺旋体 IgM 抗体阳性，尽管抗伯氏疏螺旋体 IgG 抗体阴性。这些结果表明局限性硬皮病可能与伯氏疏螺旋体密切相关，泛发性硬斑病也可能代表伯氏疏螺旋体感染。
