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PubMed1994

Comparison of four immunoserologic assays for detection of antibodies to Borrelia burgdorferi in patients with culture-positive erythema migrans.

In view of the significant sequelae associated with Lyme borreliosis, there is a need for timely and accurate diagnosis of erythema migrans (EM). Although Borrelia burgdorferi can be cultured from biopsies of EM lesions, immunodiagnostic testing is more widely available. Four immunoserologic methods were studied by using the sera of 51 patients with EM lesions that were culture positive for B. burgdorferi. Nineteen patients had single primary lesions, and thirty-two had multiple secondary lesions. At the time of biopsy, 40 patients, 8 with primary lesions and all patients with secondary lesions, were seropositive by an immunoglobulin M (IgM) indirect fluorescent-antibody (IgM IFA) test (Bion Enterprises). Twenty-three patients were seropositive by a whole-cell fluorescence enzyme immunoassay (EIA) (BioWhittaker, Inc.), twenty-two were positive by immunoblotting (ViroStat, Inc.), and one was positive by a P39 recombinant EIA (P39 EIA) (General Biometrics, Inc.). Sera from various patient control groups were tested: rheumatoid arthritis (n = 19), infectious mononucleosis (n = 20), systemic lupus (n = 22), syphilis (n = 13), streptococcal sequelae (n = 20), and healthy subjects (n = 16). None of these sera reacted with the IgM IFA test or P39 EIA. Fifteen reacted with the fluorescence EIA. We conclude that the IgM IFA test is an effective and reliable assay for the diagnosis of EM, particularly for patients with secondary lesions. Immunoblot, fluorescence EIA, and P39 EIA lack the sensitivity to reliably diagnose EM.

Adolescent↗

PubMed1996

Evolution of the serologic response to Borrelia burgdorferi in treated patients with culture-confirmed erythema migrans.

We investigated the appearance and evolution of immunoglobulin M (IgM) and IgG antibodies to Borrelia burgdorferi in 46 patients with culture-proven erythema migrans (EM). All patients received antimicrobial treatment and were prospectively evaluated for up to 1 year. A total of 257 serially collected serum samples were tested by commercial IgG-IgM enzyme-linked immunosorbent assay and separate IgM and IgG immunoblots (IBs). At the baseline, 33% of the patients had a positive ELISA result and 43% of the patients had a positive IgM IB result by using the criteria of the Centers for Disease Control and Prevention-Association of State and Territorial Public Health Laboratory Directors for the interpretation of IB results. Positive serology at the baseline and the rate of seroconversion correlated directly with disease duration and/or evidence of dissemination prior to treatment. At days 8 to 14 after the baseline, 91% of patients had a positive ELISA result and/or IgM IB result. Peak IgM antibody levels were seen at this time in patients with localized or disseminated disease. The most frequent IgM bands at the baseline and the peak were of 24 kDa (OspC), 41 kDa, and 37 kDa. Although 89% of the patients developed IgG antibodies as determined at a follow-up examination, only 22% were positive by the IgG IB criteria of the Centers for Disease Control and Prevention-Association of State and Territorial Public Health Laboratory Directors. The persistence of antibodies was directly related to disease duration and/or dissemination prior to treatment. Since IgM antibodies to the 24- and 41-kDa antigens remained detectable for long periods, 38% of IgM IBs were still positive at 1 year postbaseline. IgM to antigens of 39, 58, 60, 66, or 93 kDa, conversely, were most often seen in sera obtained within 1 month postbaseline. Their presence may be of assistance in confirming a recent infection with B. burgdorferi in individuals living in areas where Lyme disease is endemic.

Antibodies, Bacterial↗

PubMed2001

Characterization of Lyme borreliosis isolates from patients with erythema migrans and neuroborreliosis in southern Sweden.

Southern Sweden is an area of Lyme borreliosis (LB) endemicity, with an incidence of 69 cases per 100,000 inhabitants. The most frequent clinical manifestations are erythema migrans (77%) and neuroborreliosis (16%). There was no record of human Borrelia strains being isolated from patients in this region before the prospective study reported here. Borrelia spirochetes were isolated from skin and cerebrospinal fluid (CSF) from LB patients living in the region. A total of 39 strains were characterized by OspA serotype analysis, species-specific PCR, and signature nucleotide analysis of the 16S rRNA gene. Of 33 skin isolates, 31 (93.9%) were Borrelia afzelii strains and 2 (6.1%) were Borrelia garinii strains. Of six CSF isolates, five (83.3%) were B. garinii and one (16.7%) was B. afzelii. Neither Borrelia burgdorferi sensu stricto strains nor multiple infections were observed. The B. afzelii isolates were of OspA serotype 2. Three B. garinii strains were of OspA serotype 5, and the remaining four strains were of OspA serotype 6. All of the B. garinii strains belonged to the same 16S ribosomal DNA ribotype class. Our findings agree with earlier findings from other geographic regions in Europe where B. afzelii and B. garinii have been recovered predominantly from skin and CSF cultures, respectively. To further study the possible presence in Sweden of the genotype B. burgdorferi sensu stricto, which is known to be present in Europe and to occur predominantly in patients with Lyme arthritis, molecular detection of Borrelia-specific DNA in synovial samples from Lyme arthritis patients should be performed.

Antigens, Surface↗

PubMed1976

Immunoglobulin E in erythema nodosum.

Twenty-two children aged from 3 years 6 months to 12 years with erythema nodosum (EN) were grouped according to aetiology into streptococcal, tuberculous, and those whose aetiology was undetermined. Serum IgE levels were determined in all by the radioimmunosorbent technique. Levels were higher (mean value 991 units/ml) in streptococcal EN than in those of the other two groups (mean value 68 units/ml and 97 units/ml, respectively) and healthy age-matched controls (mean value 60 units/ml). Increase of IgE levels in individual cases of streptococcal EN did not correlate with severity of the clinical manifestations characteristic of that group.

Child↗

PubMed1977

Leptospirosis presenting with erythema nodosum.

An illness due to a leptospiral infection in a boy aged 12 years is described which, in addition to presenting with severe fever, malaise, and aseptic meningitis, showed the rare features of severe bradycardia and erythema nodosum.

Bradycardia↗

PubMed2000

Diagnosis, classification, and management of erythema multiforme and Stevens-Johnson syndrome.

BACKGROUND: In adults, erythema multiforme (EM) is thought to be mainly related to herpes infection and Stevens-Johnson syndrome (SJS) to drug reactions. AIMS: To investigate this hypothesis in children, and to review our experience in the management of these patients. METHODS: A retrospective analysis of 77 paediatric cases of EM or SJS admitted to the Children's Hospital in Bordeaux between 1974 and 1998. RESULTS: Thirty five cases, inadequately documented or misdiagnosed mostly as urticarias or non-EM drug reactions were excluded. Among the remaining 42 patients (14 girls and 28 boys), 22 had EM (11 EM minor and 11 EM major), 17 had SJS, and three had isolated mucous membrane involvement and were classified separately. Childhood EM was mostly related to herpes infection and SJS to infectious agents, especially Mycoplasma pneumoniae. Only two cases were firmly attributed to drugs (antibiotics). No patient died. EM and SJS sequelae were minor and steroids were of no overall benefit. CONCLUSION: In paediatric practice EM is frequently misdiagnosed. The proposal that SJS is drug related in adults does not apply to children, and in our recruitment EM and SJS are mostly triggered by infectious agents. The course of both diseases, even though dramatic at onset, leads to low morbidity and mortality when appropriate symptomatic treatment is given.

Adolescent↗

PubMed1987

Giant cell arteritis of the skin simulating erythema nodosum.

Cutaneous involvement in giant cell arteritis is quite uncommon. A patient is described who presented with pretibial skin lesions clinically indistinguishable from erythema nodosum which, on biopsy, showed subcutaneous pannicular giant cell vasculitis. Cutaneous manifestations of giant cell arteritis are subsequently reviewed.

Diagnosis, Differential↗

PubMed1976

Erythema infectiosum: an outbreak of "slapped cheek" disease in north Devon.

An outbreak of erythema infectiosum (fifth disease; megalerythema epidemicum) which occurred in a small north Devon town (population 3600) during the spring of 1975 is reported. All fifty-eight cases displayed the diagnostic "slapped cheek" appearance. Virological studies gave disappointingly negative results.

Adolescent↗

PubMed1968

Acute necrotizing lepromatous lymphadenitis: an erythema-nodosum-leprosum-like reaction in lymph nodes.

Histological examination of lymph-node biopsy specimens in 12 patients with erythema nodosum leprosum showed almost complete replacement of the node by lepromatous granuloma, together with considerable polymorph infiltration. Ziehl-Neelsen staining demonstrated numerous Mycobacterium leprae present in the nodes. The majority of these patients were very ill, and responded to prednisolone or corticotrophin.It is suggested that the histological appearances may represent an intensive inflammatory response in the lymph nodes followed by avascular aseptic necrosis.

Adrenocorticotropic Hormone↗

PubMed1985

Lowered ultraviolet minimal erythema dose in hemiplegia.

In view of recent reports of increased tanning in hemiplegic limbs, we have investigated ultraviolet (u.v.) minimal erythema dose (MED) in hemiplegia using the bilateral comparison technique. Seven of 10 patients had a lower MED in the hemiplegic arm compared to the normal side, the mean reduction being 16% (range 0-33%, P = 0.003). No patients had a higher MED in the hemiplegic arm. We review the literature regarding other non-neurological features of hemiplegia, in particular asymmetry of temperature, oedema, and finger clubbing, and we propose a vasomotor or trophic aetiology for these findings.

Erythema↗

PubMed1987

Granulomatous mastitis--a rare cause of erythema nodosum.

Granulomatous mastitis is a recently described, rare condition of unknown aetiology. It occurs in young, parous women as a tender extra-areolar breast lump and therefore needs to be differentiated from carcinoma. Histologically, a discrete granulomatous lobulitis is seen and because of morphological similarities to granulomatous thyroiditis it has been suggested it may be immunologically mediated. We present a patient in whom granulomatous mastitis presented with periarthritis and erythema nodosum, an association not previously described.

Adult↗

PubMed1975

Reiter's disease in a female, presenting as erythema nodosum.

The case history of a female who presented with erythema nodosum is described, and the diagnosis of Reiter's disease is proposed. Reference is made to literature on Reiter's disease in the female and to sacroiliac joint abnormalities which have been observed in this condition.

Adult↗

PubMed1998

Photo Koebner phenomenon in erythema-multiforme-like eruption induced by contact dermatitis due to bufexamac.

A photo Koebner phenomenon following contact dermatitis due to bufexamac is described. A 52-year-old man presented with dermatitis on his buttocks and an erythema-multiforme (EM)-like eruption near the original lesion and on sun-exposed areas. He had been using bufexamac ointment (Anderm(R)) around and inside the anus for a few weeks before he noticed exacerbation. On patch testing, he exhibited severe contact sensitivity to bufexamac. Phototesting performed on his first visit showed that he had an abnormal reaction to UVB. An EM-like eruption similar to the original lesions developed around the irradiated sites. In this case, photosensitivity does not seem to be a drug-induced photoallergy due to systemic or topical use, but rather a photo Koebner phenomenon.

Administration, Topical↗

PubMed1998

Understanding the pathogenesis of HSV-associated erythema multiforme.

Erythema multiforme (EM) is a polymorphic, often recurring eruption caused by exposure to medication or various infections, notably herpes simplex virus (HSV). Understanding the pathogenesis of HSV-associated EM (HAEM) is essential for patient management. We suggest that HAEM results from the combination of viropathic effects mediated by HSV proteins, notably DNA polymerase (Pol), and an immunological reaction to viral antigens. Presumably, viral DNA and proteins ingested by macrophages at HSV lesion sites undergo fragmentation and processing for presentation to T cells with HSV memory. HSV DNA is deposited on the skin, where it is expressed. Activated T cells are recruited to the skin site of Pol expression, directly or indirectly resulting in the generation of an inflammatory cascade. Factors potentially involved in the incidence of recurrences, lesion severity and anatomical localization include the identity of the deposited HSV genes, cutaneous capillary size, degree of vasoconstriction and ambient temperature. Evidence in support of this interpretation is reviewed.

Cytokines↗

PubMed1998

Fixed drug eruption presenting as erythema dyschromicum perstans: a flare without taking any medications.

Fixed drug eruption (FDE) can present as multiple pigmented macules that flare at fixed sites even when the patient has taken no medications. Although this presentation is not characteristic of FDE, it must be borne in mind in order to make a correct diagnosis. We describe such a patient whose condition was initially diagnosed as erythema dyschromicum perstans (EDP). Immunohistochemically intraepidermal T cells were distributed between basal and suprabasal keratinocytes in the lesional skin, a finding suggestive of FDE. A flare occurred not only with exposure to theophylline but also without exposure. A flare has never recurred and pigmented macules faded gradually after avoiding theophylline. On the basis of these findings, we recommend that patients with an EDP-like presentation be examined completely for causes such as drugs before labeling the cutaneous lesions.

Child↗

PubMed1999

Longitudinal study of a patient with herpes-simplex-virus-associated erythema multiforme: viral gene expression and T cell repertoire usage.

BACKGROUND: Erythema multiforme is a polymorphous self-limited, often recurrent eruption that can follow herpes simplex virus (HSV) infection, hereby designated HAEM. Studies of relatively large groups of patients during one recurrent episode indicated that HAEM pathogenesis is associated with HSV gene expression, Vbeta2 T cell infiltration of lesional skin and altered T cell receptor (TCR) repertoire usage by HSV-stimulated peripheral blood mononuclear cells (PBMC). However, HAEM recurrences are not always preceded by overt HSV eruptions and virus cannot be isolated from HAEM lesional skin. Therefore, it is unknown whether all HAEM recurrences experienced by a given patient are HSV related. OBJECTIVE: The studies described in this report were designed to examine whether all HAEM recurrences experienced by a given patient are HSV related. METHODS: We describe one patient who was studied longitudinally during 6 HAEM recurrences and in the intervening lesion-free periods. Lesional skin from all HAEM episodes was studied for HSV gene expression and infiltration by Vbeta2 and Vbeta3 T cells. PBMC obtained at these times were assayed for TCR repertoire usage upon HSV stimulation. RESULTS: Lesional skin from all HAEM episodes was positive for HSV gene expression (RNA and protein) as well as Vbeta2 T cell infiltration. HSV-stimulated PBMC obtained at these times had an altered TCR repertoire characterized by a predominance of Vbeta2 cells. The duration of viral gene expression, Vbeta2 cell infiltration and altered TCR repertoire usage correlated with the duration of clinical symptoms. CONCLUSION: The data suggest that HSV and a virus-specific immunopathology component are involved in the causation of all HAEM episodes experienced by the patient.

Adult↗

PubMedDate not supplied

Photoprotection by Cichorum endivia extracts: prevention of UVB-induced erythema, pyrimidine dimer formation and IL-6 expression.

In the gradual process of evolution, plants have developed natural sun protecting substances that enable continuous survival under direct and intense ultraviolet (UV) radiation. As part of our studies of plant-derived pigments that might constitute an alternative to conventional sunscreens, we have tested the ethanolic extracts of roots, stalks, and inflorescences of populations of wild Cichorum endivia subsp. Divaricatum (Asteraceae) in terms of protection against sunburn, and in prevention of UVB-induced pyrimidine dimer formation and IL-6 mRNA expression in the human keratinocyte cell line, HaCaT. Using ELISA technique for detection of pyrimidine dimers and RT-PCR for detection of IL-6, we found that the ethanolic extract of C. endivia roots absorbs radiation in the UVB spectrum and partially prevents induction of pyrimidine dimers and IL-6 expression. Application of the root extract on the skin prior to UVB irradiation totally prevented erythema. Our findings suggest that C. endivia extracts might possess sun-protective qualities that make them useful as sunscreens.

Administration, Cutaneous↗

PubMed2003

Detection of herpes simplex virus genomic DNA in various subsets of Erythema multiforme by polymerase chain reaction.

BACKGROUND: The wide variation in the detection of herpes simplex virus (HSV) DNA (36-75%) by polymerase chain reaction (PCR) in erythema multiforme (EM) may be partly attributed to differences in case selection in terms of subsets of EM studied. OBJECTIVE: To determine the frequencies of detection of HSV DNA in specific subsets of EM. METHODS: Nested PCR was used to detect HSV DNA in skin biopsies with histologically proven EM. RESULTS: PCR was performed on skin biopsies from 63 patients with EM. HSV DNA was detected in 3/11 (27.2%) of single-episode HSV-associated EM (HAEM), 6/10 (60%) of recurrent HAEM, 1/4 (25%) of single-episode idiopathic EM and 6/12 (50%) of recurrent idiopathic EM. HSV DNA was not detected in atypical EM (0/11), suspected drug-induced EM (0/9) or Stevens-Johnson syndrome (0/6). CONCLUSION: The overall PCR positive rates of HAEM (42.9%) and idiopathic EM (43.8%) were comparable suggesting that idiopathic EM is likely to be related to a subclinical HSV infection.

Biopsy↗