INFECTION BY BORRELIA-BURGDORFERI AND CUTANEOUS B-CELL LYMPHOMA

In past years, association of primary cutaneous B-cell lymphoma (CBCL) with infection by Borrelia burgdorferi has been reported in a few pat ients. The evidence for a pathogenetic role was based on clinical grou nds or raised titre of antibodies in serum. Both methods, however do n ot prove the association between the micro-organism and the CBCL, espe cially in countries where infection by Borrelia burgdorferi is endemic . Moreover, the exact percentage of Borrelia burgdorferi-positive CBCL is not known. We retrieved from our files 50 cases of CBCL to perform PCR analysis of Borrelia burgdorferi DNA on paraffin-embedded tissue sections. Only patients with primary CBCL were selected. In all cases, monoclonality of the infiltrate was confirmed by immunohistological p attern of immunoglobulin light chains or molecular analysis of J(H) ge ne rearrangement, or both. Specific DNA sequences of Borrelia burgdorf eri were identified in cutaneous lesions from 9 patients (follicle cen ter lymphoma: 3/20; immunocytoma: 3/4; marginal zone B-cell lymphoma: 2/20; diffuse large B-cell lymphoma: 1/6), Specificity was confirmed b y Southern blot hybridisation in all positive cases. We could show tha t Borrelia burgdorferi DNA is present in skin lesions from a small pro portion of patients (18%) with various types of CBCL. Our results may have therapeutic implications. In analogy to Helicobacter pylori-assoc iated MALT-lymphomas, which in some cases can be cured by eradication of Helicobacter pylori infection, a proportion of CBCL may be cured wi th antibiotic therapy against Borrelia burgdorferi. Although yet specu lative, adequate antibiotic treatment for patients with primary CBCL s hould be considered before more aggressive therapeutic options are app lied, particularly in countries where infection by Borrelia burgdorfer i is endemic. PCR analysis of Borrelia burgdorferi DNA is a fast test that should be performed in all patients with CBCL to identify those w ho more likely could benefit from an early antibiotic treatment. (C) M unksgaard 1997.