Sudeck's atrophy in Lyme borreliosis

A patient with disseminated Lyme borreliosis is reported. The patient suffered from erythema migrans and radicular pain. Serologic tests routinely performed (IFT, ELISA, Western blots with different strains and Borrelia-LTT) were negative. However, Borrelia burgdorferi (genotype Borrelia afzelii) was cultivated from a skin biopsy. Western blot with the patient's isolate and sera showed strong reactivity only with the 60 kDa protein. In spite of immediate diagnosis and intravenous antibiotic treatment according to current recommendations he developed pain in the right ankle, which was resistant to further antibiotic and anti-inflammatory therapy. Sudeck's atrophy was diagnosed by X-ray. Treatment with calcitonin brought immediate relief from pain and led to radiographically demonstrable recalcification.