Boyé T
Service de dermatologie, hôpital d'instruction des armées Legouest, 27, avenue de Plantières, BP10, 57998 Metz Armées, France.
Med Mal Infect. 2007 Dec;37 Suppl 3:S175-88. doi: 10.1016/j.medmal.2007.10.002. Epub 2007 Dec 11.
Lyme borreliosis (BL) is a multisystem infectious tick-transmitted disease. The diversity of Borrelia burgdorferi is the reason for a wide spectrum of dermatological and ophthalmologic presentations between patients from Europe and from other countries. In Europe, the main manifestations are dermatological. During the early stage, the diagnosis is clinical: finding erythema migrans (EM) a few days after a tick bite is sufficient; several EM mean an early-disseminated disease. Borrelial lymphocytoma (only in Europe) is a solitary nodule or plaque (earlobe, nipple, scrotum), which appears during the second stage. The diagnosis relies on clinical and histological findings (B-cell infiltration) and a positive serological test. It is sometimes difficult to make the difference between BL and B-cell lymphoma and pseudo lymphoma; an empirical antibiotic trial period will be helpful for the diagnosis in this case. During the late stage, the clinical evolution of acrodermatitis chronica atrophicans is progressive: inflammatory then atrophic lesions appear, often on the hands, limbs, or feet. The diagnosis is made on histological findings (T-cell infiltration) and a positive serological test. The relationship between BL and morphea or lichen sclerosus was not demonstrated according to the latest reports. Ocular manifestations are rare events occurring during every stage of the disease. A wide spectrum of presentations is possible (uveitis and optic neuritis). BL is responsible for ocular infection or inflammation. A neurological presentation is often associated with the ocular manifestation. Proving the diagnosis is often difficult because of these polymorphous manifestations.
莱姆病（BL）是一种由蜱传播的多系统感染性疾病。伯氏疏螺旋体的多样性导致欧洲患者与其他国家患者在皮肤和眼科表现上存在广泛差异。在欧洲，主要表现为皮肤症状。在疾病早期，诊断依靠临床症状：蜱叮咬数天后发现游走性红斑（EM）即可确诊；出现多个EM意味着疾病处于早期播散阶段。伯氏淋巴细胞瘤（仅在欧洲出现）是单个结节或斑块（耳垂、乳头、阴囊），出现在疾病第二阶段。诊断依靠临床和组织学检查结果（B细胞浸润）以及血清学检测呈阳性。有时很难区分莱姆病与B细胞淋巴瘤及假性淋巴瘤；在这种情况下，进行经验性抗生素试验期有助于诊断。在疾病晚期，慢性萎缩性肢端皮炎的临床进展是渐进性的：先是出现炎症性病变，然后是萎缩性病变，常见于手部、四肢或足部。诊断依据组织学检查结果（T细胞浸润）和血清学检测呈阳性。根据最新报告，未证实莱姆病与硬斑病或硬化性苔藓之间存在关联。眼部表现是疾病各阶段均可能出现的罕见情况。可能出现多种表现（葡萄膜炎和视神经炎）。莱姆病可导致眼部感染或炎症。神经系统表现常与眼部表现相关。由于这些表现多样，确诊往往很困难。
