Isolation and polymerase chain reaction typing of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcerating bullous lichen sclerosus et atrophicus

A 64-year-old woman presented with bullous and ulcerating lichen sclerosus et atrophicus (LSA) on the neck, trunk, genital and perigenital area and th e extremities. Histology of lesional skin showed the typical manifestations of LSA; in one of the biopsies spirochaetes were detected by silver staini ng. Despite treatment with four courses of ceftriaxone with or without meth ylprednisone for up to 20 days, progression of LSA was only stopped for a m aximum of 1 year. Spirochaetes were isolated from skin cultures obtained fr om enlarging LSA lesions. These spirochaetes were identified as Borrelia af zelii by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and pol ymerase chain reaction (PCR) analyses. However serology for B. burgdorferi sensu lato was repeatedly negative. After one further 28-day course of ceft riaxone the lesions stopped expanding and sclerosis of the skin was diminis hed. At this time cultures for spirochaetes and PCR of lesional skin for B. afzelii DNA remained negative. These findings suggest a pathogenetic role for B. afzelii in the development of LSA and a beneficial effect of appropr iate antibiotic treatment.