Schempp C, Bocklage H, Owsianowski M, Lange R, Orfanos C E, Gollnick H
Universitäts-Hautklinik und Poliklinik, Freien Universität Berlin.
Hautarzt. 1993 Jan;44(1):14-8.
No decision has been made yet as to whether or not the origin of the circumscribed scleroderma (morphea) is spirochetal. We describe a morphea-like skin lesion that developed after a tick bite 10 years ago. The histological investigation showed sclerodermal characteristics and necrobiosis lipoidica of the granulomatous type as well. No antibodies directed against Borrelia burgdorferi could be detected absorbance by a flagellin ELISA or by Western blot analysis. The VDRL, TPHA and FTA absorbance test, Warthin-Starry staining, and cultivation of Borrelia from skin biopsies were negative. The application of a nested polymerase chain reaction (PCR), relying on a combination of flagellin-gene-specific primers, demonstrated for the first time the presence of Borrelia DNA in a morphealike skin lesion. Immunohistological examination of the skin by a monoclonal antibody directed against flagellin was positive. Furthermore, in vitro GM-CSF secretion and lymphocyte proliferation upon stimulation with Borrelia-antigen was elevated and decreased significantly after 3 weeks of treatment with tetracyclines. In this case PCR analysis, immunohistochemistry and cellular immune response confirmed an infection with Borrelia, although no serum antibodies against spirochetal antigens could be detected.
关于局限性硬皮病（硬斑病）的病因是否为螺旋体感染，目前尚无定论。我们描述了一例10年前蜱叮咬后出现的硬斑病样皮肤损害。组织学检查显示有硬皮病特征以及肉芽肿型类脂质渐进性坏死。通过鞭毛蛋白酶联免疫吸附测定（ELISA）或免疫印迹分析，均未检测到抗伯氏疏螺旋体的抗体。性病研究实验室玻片试验（VDRL）、梅毒螺旋体血凝试验（TPHA）和荧光螺旋体抗体吸收试验（FTA）、Warthin-Starry染色以及从皮肤活检组织中培养伯氏疏螺旋体均为阴性。应用基于鞭毛蛋白基因特异性引物组合的巢式聚合酶链反应（PCR），首次在硬斑病样皮肤损害中检测到伯氏疏螺旋体DNA。用抗鞭毛蛋白单克隆抗体对皮肤进行免疫组织学检查呈阳性。此外，用伯氏疏螺旋体抗原刺激后，体外粒细胞-巨噬细胞集落刺激因子（GM-CSF）分泌和淋巴细胞增殖增加，四环素治疗3周后显著下降。在该病例中，PCR分析、免疫组织化学和细胞免疫反应证实存在伯氏疏螺旋体感染，尽管未检测到抗螺旋体抗原的血清抗体。
