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May 01, 2008

Symmetrical Reddish Swelling of the Eyebrows in a 12-Year-Old Girl—Diagnosis

Author Affiliations
 

CARRIE ANN R.CUSACKSENAIT W.DYSONMDJACQUELINE M.JUNKINS-HOPKINSMDVINCENTLIUMDKARLA S.ROSENMANMD

Arch Dermatol. 2008;144(5):673-678. doi:10.1001/archderm.144.5.673-g

Histologic examination showed a dense lymphoid infiltrate in the dermis with formation of confluent germinal centers, surrounded by a small mantle zone (Figure 2). Numerous “tingible body” macrophages were present within the germinal centers (Figure 3), which were outlined by CD21-positive follicular dendritic cells. The germinal center cells were positive for CD20, CD10, and Bcl-6 and negative for Bcl-2. The proliferation marker MIB-1 (Ki-67) showed a normal (high) proliferation of germinal center cells. Molecular analysis of the immunoglobulin heavy chain (IGH) gene rearrangement by polymerase chain reaction (PCR) revealed a polyclonal smear. Based on these findings, a diagnosis of lymphocytoma cutis was made. Association with Borrelia burgdorferi infection could be confirmed by PCR analysis from the paraffin material, demonstrating the presence of a specific band at the expected length. Serologic findings from B burgdorferi infection showed positive IgG, but negative IgM, antibodies. The patient was treated with amoxicillin trihydrate (500 mg, 3 times a day, for 3 weeks), and both lesions resolved completely over 2 months.

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