To report the case of acrodermatitis chronica atrophicans as an ocularpalpebral manifestation of Lyme borreliosis, with peripheral keratopathy and associated vasculitis.
A 16-year-old girl, with a 4-year history of recurrent left eye photophobia, intense redness, and superior eyelid edema, presented with lid erythema, ptosis, superficial venous tortuosity, conjunctival hyperemia, corneal thinning with precipitates, and vascularization. Borrelia burgdorferi was confirmed by immunoblotting. Treatments with doxycycline followed by ceftriaxone were only partially effective. Eyelid biopsy revealed spirochetes and vasculitis with deposition of immunoglobulin G. Oral cefuroxime for 28 days was ineffective. Due to the vasculitis, immunosuppression with azathioprine and topical cyclosporine were given for 4 months. Since then she has been free of flare-ups.
Lyme borreliosis should be considered in patients with recurrent chronic lid edema and associated keratopathy.
*IOBA (Institute of Applied Bio-Ophthalmology), University of Valladolid, Valladolid, Spain
†Infectious Diseases Unit, ‘Infanta Cristina' University Hospital and Department of Biomedical Sciences, Faculty of Medicine, University of Extremadura, Badajoz, Spain
‡CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials and Nanomedicine), Valladolid, Spain.
Reprints: Margarita Calonge, IOBA, University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belen 17, Valladolid E-47011, Spain (e-mail: firstname.lastname@example.org).
Supported by CIBER-BBN, Carlos III Health Institute, Spain, Junta de Castilla y León (SAN 1178/200). G. Murillo and B. E. Ramirez received scholarships from the Carolina Foundation, Ministry of Foreign Affairs, Spain.
The authors have no conflicts of interest to disclose.
Received September 7, 2011
Accepted November 22, 2011