Erythema migrans Afzelius-Lipschutz chronic erythema: causes, symptoms, diagnosis, treatment

Erythema anulare chronicum migrans of Afzelius-Lipschütz (syn. erythema anulare chronicum migrans) is a manifestation of the first stage of borreliosis, an infectious disease caused by a spirochete of the genus Borrelia, transmitted by tick bites. Clinically, it is manifested by the development of a reddish-bluish spot at the site of the tick bite, slightly elevated above the skin. Due to peripheral growth, the lesion can take on round, oval or polycyclic outlines and reach gigantic sizes, while its central part regresses, and an erythematous border remains along the periphery. During the progression period, the peripheral border is not interrupted. In the center, at the site of the bite, a hemorrhagic or pigmented point remains for a long time. The lesion without treatment exists for several weeks or months, then other signs of borreliosis develop: lymphocytomas, idiopathic progressive atrophy of the skin. In addition to skin changes, there may be malaise, muscle pain, lymphadenopathy, fever, arthralgia, cardiovascular, neurological and other symptoms.

Pathomorphology of Afzelius-Lipschütz erythema migrans chronica. In the acute stage of the inflammatory process, there is a hemorrhagic crust on the surface of the affected epidermis, and in the Malpighian layer - exocytosis of erythrocytes and eosinophilic granulocytes. In the dermis - pronounced edema and perivascular infiltrates of eosinophilic granulocytes, lymphocytes and a small number of tissue basophils. In the subacute stage, the epidermis is without special changes, only slightly thickened in places, in the middle and lower parts of the dermis - mainly perivascular infiltrate consisting of lymphocytes surrounded by neutrophilic and eosinophilic granulocytes and mononuclear elements located in its central part, as a result of which the histological picture resembles lymphatic follicles. In the chronic stage, the epidermis is thickened, in the dermis - fibrosis. In some places, one can encounter giant cells of foreign bodies, small infiltrates of lymphocytes and eosinophils with an admixture of a large number of tissue basophils.