Fesler Melissa C, Middelveen Marianne J, Burke Jennie M, Stricker Raphael B
1 Union Square Medical Associates, San Francisco, CA, USA.
2 Atkins Veterinary Services, Calgary, Alberta, Canada.
J Investig Med High Impact Case Rep. 2019 Jan-Dec;7:2324709619842901. doi: 10.1177/2324709619842901.
We describe a case of acute erosive vulvovaginitis accompanying Borrelia burgdorferi infection. The patient is a 57-year-old woman previously diagnosed with Lyme disease who presented with a painful erosive genital lesion. At the time of the outbreak, she was being treated with oral antibiotics, and she tested serologically positive for B burgdorferi and serologically negative for syphilis. Histological examination of biopsy tissue from the lesion was not characteristic of dermatopathological patterns typical of erosive vulvar conditions. Dieterle-stained biopsy sections revealed visible spirochetes throughout the stratum spinosum and stratum basale, and anti- B burgdorferi immunostaining was positive. Motile spirochetes were observed by darkfield microscopy and cultured in Barbour-Stoner-Kelly-complete medium inoculated with skin scrapings from the lesion. Cultured spirochetes were identified genetically as B burgdorferi sensu stricto by polymerase chain reaction, while polymerase chain reaction amplification of treponemal gene targets was negative. The condition resolved after treatment with additional systemic antibiotic therapy and topical antibiotics. In cases of genital ulceration that have no identifiable etiology, the possibility of B burgdorferi spirochetal infection should be considered.
我们描述了一例伴有伯氏疏螺旋体感染的急性糜烂性外阴阴道炎病例。患者为一名57岁女性，此前被诊断为莱姆病，此次因疼痛性糜烂性生殖器病变就诊。发病时，她正在接受口服抗生素治疗，血清学检测伯氏疏螺旋体呈阳性，梅毒血清学检测呈阴性。病变活检组织的组织学检查并非典型糜烂性外阴疾病的皮肤病理模式特征。迪特尔勒染色的活检切片显示，在棘层和基底层可见螺旋体，抗伯氏疏螺旋体免疫染色呈阳性。通过暗视野显微镜观察到活动的螺旋体，并在接种病变皮肤刮屑的巴伯-斯托纳-凯利完全培养基中培养。通过聚合酶链反应将培养的螺旋体基因鉴定为狭义伯氏疏螺旋体，而梅毒螺旋体基因靶点的聚合酶链反应扩增为阴性。经额外的全身抗生素治疗和局部抗生素治疗后，病情得到缓解。在病因不明的生殖器溃疡病例中，应考虑伯氏疏螺旋体感染的可能性。
