Krol Charlotte G, van der Geer Simone, Thio H B Bing, Janssen Martien J F M, Jonkers Gé J P M
Rijnland ziekenhuis, Afd. Interne Geneeskunde, Leiderdorp, the Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A2012.
A 71-year-old man was referred to our outpatient clinic because of arthralgia and swelling of his right hand. He also showed a subcutaneous nodule on his left knee. A second patient, a 57-year-old woman, was referred because of painful skin of her legs. Dermatologic examination revealed erythematous livid discoloration on both feet and legs. There were reticular varices, corona flebectatia paraplantaris medialis and minimal pitting oedema. Serology tested positive in both patients for Borrelia and they both recalled tick bites. A third patient, a 73-year-old woman, was referred because of erythema and maculae located at her lower legs and positive Borrelia serology. Pathologic examination was typical for acrodermatitis chronica atrophicans, a late skin manifestation of Lyme borreliosis. In all patients, symptoms improved after treatment with doxycycline for four weeks. A lack of familiarity with this skin condition may lead to unnecessary vascular investigations and considerable delay in adequate treatment.
一名71岁男性因右手关节疼痛和肿胀被转诊至我们的门诊。他的左膝还出现了一个皮下结节。另一名患者，一名57岁女性，因腿部皮肤疼痛前来就诊。皮肤科检查发现双足和双腿有红斑性青紫色变色。存在网状静脉曲张、足底内侧静脉扩张和轻度凹陷性水肿。两名患者的血清学检测均显示伯氏疏螺旋体呈阳性，且他们都回忆起曾被蜱叮咬过。第三名患者，一名73岁女性，因小腿出现红斑和斑疹以及伯氏疏螺旋体血清学阳性前来就诊。病理检查结果为慢性萎缩性肢端皮炎的典型表现，这是莱姆病的一种晚期皮肤表现。所有患者在接受四周强力霉素治疗后症状均有所改善。对这种皮肤疾病缺乏了解可能会导致不必要的血管检查，并在适当治疗方面造成相当大的延误。
