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Pathology of Erythema Chronicum Migrans

Dr Sampurna Roy MD





Erythema chronicum migrans is a skin lesion of the tick borne spirochetosis, Lyme disease.

The annular lesion, (measures 5-20 cm in diameter) develops within 3 months of the tick bite.

Lesions are multiple in some cases.

Secondary erythema migrans result from hematogenous spread of the organism.

The organism disappear from the lesion after treatment with antibiotics (doxycycline and synthetic penicillin).

Microscopic features:

Histologically, there is a superficial and deep perivascular and interstitial infiltrate of lymphocytes.

In some cases plasma cells and eosinophils are present. Eosinophils may be present at the site of tick bite. A few neutrophils may also be noted.

Special stain : Warthin-Starry silver stain - In some specimens  spirochetes are identified in the papillary dermis at the dermoepidermal junction.

Diagnosis may be confirmed by using an indirect immunofluorescence or immunoperoxidase techniques.

Borellia burgdorferi may also be identified in formalin-fixed paraffin-embedded lesions by polymerase chain reaction method. 

Visit:  Lyme Disease (Lyme Borreliosis) ; Acrodermatitis chronica atrophicans

Further reading:

Multilocular erythema migrans in borreliosis.

Development of erythema migrans in spite of treatment with antibiotics after a tick bite.

Erythema migrans and serodiagnosis by enzyme immunoassay and immunoblot with three borrelia species

Epidemiological study of a cohort of adult patients with Erythema migrans registered in Slovenia in 1993.

The clinical spectrum of early Lyme borreliosis in patients with culture-confirmed erythema migrans.

Skin Pathology. D Weedon




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)








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