Acrodermatitis chronica atrophicans in association with lichen sclerosus et atrophicans: tubulo-interstitial nephritis and urinary excretion of spirochete-like organisms.

We report about a 38-year-old male patient with coexisting acrodermatitis chronica atrophicans, lichen sclerosus et atrophicans and recurrent diabetic metabolic disorders since 9 years. Serologically IgG antibodies against Borrelia burgdorferi could be detected. Moveless winded structures, morphologically resembling borreliae could be demonstrated in the urine sediment by dark field microscopy. Additionally a tubulo-interstitial nephritis was diagnosed by the presence of a dysmorphic hematuria, a pathological polyacrylamide gel electrophoresis and raised alpha 1- and beta 2-microglobulin in the urine. We suggest that the excreted spirochete-like structures are borreliae. They may be the putative infectious agent for the development of lichen sclerosus et atrophicans in the genital area.