LYMPHOPROLIFERATIVE RESPONSES TO BORRELIA-BURGDORFERI IN PATIENTS WITH ERYTHEMA MIGRANS, ACRODERMATITIS CHRONICA ATROPHICANS, LYMPHADENOSISBENIGNA CUTIS, AND MORPHEA

Background and Design: Specific humoral and cell-mediated immune respo nses play an important role in the pathogenesis of Lyme borreliosis. S everal previous studies demonstrated that a specific cellular immune r esponse to Borrelia burgdorferi can occur independently of a diagnosti c humoral response. Little is known about T-cell reactivities against B burgdorferi in early and late cutaneous manifestations of Lyme borre liosis. We studied the lymphoproliferative response of peripheral bloo d mononuclear cells to B burgdorferi antigen from 99 patients (25 with erythema migrans, 16 with acrodermatitis chronica atrophicans, 13 wit h lymphadenosis benigna cutis, and 45 with localized scleroderma) and 21 control subjects. The results are expressed as a stimulation index (SI) (mean count per minute of triplicate cultures with stimulant divi ded by mean count per minute without stimulant). The serum samples fro m all patients and control subjects were tested for antibodies to B bu rgdorferi by indirect immunofluorescence assay. Results: The 21 health y seronegative controls had an SI of 3.3 +/- 2.0 (mean +/- SD). Compar ed with that of control subjects, the SIs were significantly elevated in patients with erythema migrans (9.8 +/- 9.1), acrodermatitis chroni ca atrophicans (11.8 +/- 8.2), and lymphadenosis benigna cutis (7.2 +/ - 6.2). The 45 patients with localized scleroderma had elevated prolif erative responses, with an SI of 6.5 +/- 7.3, but these responses did not significantly differ from those of controls. Elevated titers of an tibodies to B burgdorferi were present in six (24%) of 25 patients wit h erythema migrans, five (38%) of 13 patients with lymphadenosis benig na cutis, and 13 (29%) of 45 patients with localized scleroderma. All 16 patients with acrodermatitis chronica atrophicans had markedly elev ated antibody titers.