October 26, 1994

Identification of Borrelia burgdorferi in Diffuse Fasciitis With Peripheral Eosinophilia: Borrelial Fasciitis

Author Affiliations

From the Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (Drs Granter, Barnhill, and Duray), and Reference Diagnostic Division, Imugen Inc, Norwood, Mass (Ms Hewins).

JAMA. 1994;272(16):1283-1285. doi:10.1001/jama.1994.03520160067045

Objective.  —To determine if spirochetes could be localized in biopsy specimens of patients with diffuse fasciitis and peripheral eosinophilia.

Patients.  —Tissue from two patients received in consultation and retrieved from hospital files. One patient had a history of tick bite and erythema migrans.

Setting.  —Tertiary care center and pathology consultation practice.

Methods.  —Multiple tissue sections were examined for spirochetes using the modified Dieterle or Steiner technique. One case was examined using rabbit polyclonal antibodies against Borrelia burgdorferi. One case had sufficient tissue to study for B burgdorferi DNA by polymerase chain reaction.

Results.  —We identified two cases of diffuse fasciitis associated with peripheral eosinophilia in which spirochetal organisms were identified. The two patients had positive or borderline B burgdorferiserological findings. Deep biopsy was diagnostic of diffuse fasciitis with eosinophilia. In one patient, multiple organisms were seen using a modified Dieterle silver stain, and B burgdorferi—specific DNA was amplified by polymerase chain reaction. In the other patient, no unequivocal organisms were detected on silver stain; however, organisms were detected using rabbit polyclonal antibodies against B burgdorferi.

Conclusion.  —Some cases of what has previously been described as "eosinophilic" fasciitis may be an expression of Lyme disease, and we propose the more specific term borrelial fasciitis to describe such lesions.(JAMA. 1994;272:1283-1285)