RHEUMATIC MANIFESTATIONS RELATED TO ACRODERMATITIS CHRONICA ATROPHICANS - A REVIEW OF 4 CASES

Background. Acrodermatitis chronica atrophicans is a delayed manifesta tion of Lyme disease caused by a Borrelia burgdorferi subspecies, B. a fzelii. Although rheumatic manifestations are rare, they can result in deformities of the fingers and toes if they are not treated promptly. Methods. We report four cases of acrodermatitis chronica atrophicans seen over a 15-year period. Results. Two patients had a noninflammator y unilateral knee effusion and one had swelling of the dorsum of one h and. Antimicrobial therapy was followed by a full recovery in the thre e patients who received an early diagnosis. The remaining patient, a 6 3-year-old woman, had swelling and dysesthesia in the fingers of both hands. She developed finger deformities over a period of two years. Al though the swelling resolved under antimicrobial therapy, she had pers istent reducible deformities of the fingers consistent with Jaccoud's arthropathy. Conclusion. The diagnosis of acrodermatitis chronica atro phicans rests on a history of a tick bite, a suggestive skin biopsy hi stology and a positive Western blot for B. afzelii. A positive respons e to antimicrobial therapy is also required. Acrodermatitis chronica a trophicans, a common condition in central and northern Europe, can cau se joint manifestations and persistent finger deformities in the absen ce of early treatment.