A Case of Early Lyme Disease Diagnosed by Polymerase Chain Reaction

• Main Authors: Utku KAVRUK, Selçuk KILIÇ, İlyas SAYAR, Bekir ÇELEBİ
• Format: Article
• Language: English
• Published: Bilimsel Tip Yayinevi 2012-12-01
• Series: Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi
• Subjects: Lyme disease; Borrelia burgdorferi; Polymerase chain reaction; Serology; Turkey
• Online Access: http://www.floradergisi.org/getFileContent.aspx?op=REDPDF&file_name=2012-17-04-192-197.pdf

Lyme borreliosis, or Lyme disease, is a tick-transmitted disease caused by the spirochete Borrelia burgdorferi. Infection with B. burgdorferi sensu lato can result in a multisystemic disease that involves dermatological, neurological, cardiac, and musculoskeletal disorders. Lyme borreliosis is the most frequent tick-borne disease in the northern hemisphere. Although the first cases in Turkey were reported after the 1990’s, and the causative agent was isolated from the tick vectors, little is known about the epidemiology of Lyme borreliosis in Turkey, and data are based mainly on case reports. In this report, a case of Lyme borreliosis confirmed with not only serological tests but also polymerase chain reaction positivity is presented for the first time in Turkey. In April 2011, a 48-year-old previously healthy female was admitted to our hospital with the complaints of fever, myalgia, and erythematous, painful, pruritic cutaneous lesions on her right arm. The patient had no history of tick or arthropod bite. The findings of the physical examination were remarkable for fever and localizing signs of infection with crusted skin lesions and dissimilar erythema migrans on the dorsum of her right arm. Right epitrochlear and axillary lymphadenopathy were also noted. Laboratory studies revealed a C-reactive protein level of 7.2 mmol/L, while other results were unremarkable. Histopathological investigation of dermal biopsy revealed perivascular inflammatory infiltrate of lymphoplasmacytoid, suggestive of Lyme disease. The diagnosis of Lyme borreliosis was confirmed by real time-PCR positivity in samples taken from the skin lesions, while serum samples were negative. This case was treated with doxycycline for 21 days and became afebrile within five days. To the best of our knowledge, this is the first polymerase chain reaction-proven case of Lyme borreliosis in Turkey. This case is presented in order to remind that Lyme borreliosis should be kept in mind in a patients from rural areas presenting with cutaneous lesion, irrespective of the presence or not of characteristic lesion (erythema migrans) and exposure to tick bite.