Introduction:

Borrelial lymphocytoma, also known as lymphadenosis benigna cutis or lymphocytic adenoma, is a rare skin manifestation of Lyme borreliosis caused by the spirochete bacterium Borrelia burgdorferi. This article provides an overview of Borrelial lymphocytoma, including its symptoms, diagnostic methods, and treatment options. Understanding the clinical features and appropriate management of Borrelial lymphocytoma is crucial for accurate diagnosis and timely intervention.

Symptoms:

• Skin Lesion: Borrelial lymphocytoma typically presents as a solitary, painless, bluish-red or violaceous nodule on the skin. The lesion is usually located near a tick bite site, such as the earlobe, nipple, or scrotum. It may gradually increase in size over weeks to months.
• Lymph Node Enlargement: Along with the skin lesion, regional lymph node enlargement can occur. The affected lymph nodes may become swollen, tender, and firm to the touch. The involvement of lymph nodes is more common in children than in adults.
• Systemic Manifestations: In rare cases, systemic symptoms like fever, malaise, and headache may accompany Borrelial lymphocytoma. However, these systemic manifestations are less common compared to other Lyme borreliosis manifestations.

Diagnosis:

• Clinical Evaluation: The diagnosis of Borrelial lymphocytoma is primarily based on clinical evaluation, including a thorough examination of the skin lesion and associated lymph nodes. The characteristic appearance of the skin lesion, coupled with the presence of regional lymphadenopathy, is suggestive of Borrelial lymphocytoma.
• Serologic Testing: Serologic testing for Borrelia burgdorferi antibodies can be performed to support the diagnosis. Enzyme immunoassays (EIAs) and Western blot assays are commonly used to detect specific antibodies. However, it's important to note that serologic testing may not always be conclusive, especially in the early stages of infection.

Treatment:

• Antibiotic Therapy: The treatment of Borrelial lymphocytoma typically involves a course of antibiotics to eliminate the underlying infection. Oral antibiotics, such as doxycycline or amoxicillin, are commonly prescribed for a few weeks. In some cases, intravenous antibiotics like ceftriaxone may be necessary for severe or refractory lymphocytomas.
• Follow-Up: Regular follow-up with a healthcare provider is essential to monitor the response to treatment and ensure complete resolution of the skin lesion and associated symptoms.

Prevention:

• Tick Bite Prevention: Minimizing exposure to ticks is crucial for preventing Lyme borreliosis and its manifestations, including Borrelial lymphocytoma. Individuals should take precautions such as wearing protective clothing, using insect repellents, and performing thorough tick checks after potential exposure to tick-infested areas.
• Prompt Tick Removal: If a tick is found attached to the skin, it should be promptly and carefully removed using fine-tipped tweezers. Grasping the tick as close to the skin's surface as possible and pulling upward with steady, even pressure can help minimize the risk of disease transmission.

Conclusion:

Borrelial lymphocytoma is a rare skin manifestation of Lyme borreliosis characterized by a distinctive skin lesion and regional lymph node enlargement. Prompt diagnosis, appropriate antibiotic treatment, and regular follow-up are crucial for successful management and resolution of the condition. Public education on tick bite prevention and prompt tick removal plays a vital role in preventing Lyme borreliosis and associated manifestations.

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