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Early Erythema Migrans: Do Not Count on Plasma Cells
Candice E Brem1, Lynne J Goldberg
1Section of Dermatopathology, Department of Dermatology, Boston University School of Medicine, Boston, MA.
Early Lyme disease diagnosis can be challenging. Skin biopsies showing a specific pattern of histiocytes without plasma cells can suggest erythema migrans, even with negative initial serology.
Area of Science:
- Dermatopathology
- Infectious Diseases
Background:
- Lyme disease affects 300,000 Americans annually.
- Erythema migrans is the earliest sign, preceding serologic conversion.
- Skin biopsies aid early Lyme disease diagnosis.
Observation:
- Histopathology of erythema migrans typically shows a mixed inflammatory infiltrate.
- Findings vary based on biopsy location within the lesion.
- A case presented with a subtle histiocyte infiltrate without plasma cells.
Findings:
- The specific biopsy pattern observed was a superficial and deep perivascular and interstitial infiltrate of histiocytes.
- Plasma cells were notably absent in this early-stage erythema migrans biopsy.
- This presentation differs from typical histopathologic findings.
Implications:
- Dermatopathologists should consider erythema migrans with this subtle histiocyte pattern.
- Early diagnosis is crucial for effective Lyme disease treatment.
- Awareness of atypical biopsy findings improves diagnostic accuracy.
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