Borrelia lymphocytomas are nodule-like thickenings on the skin. The bright red to blue-red swellings often indicate a Borrelia infection caused by a tick bite, but they can also be caused by viruses. The bulging skin thickenings are mainly caused by immigration of B and T lymphocytes and can be differentiated from malignant B-cell lymphomas by analysis of the cell types present.
What is a Borrelia lymphocytoma?
The appearance of Borrelia lymphocytomas is similar to that of malignant lymphomas, which are characterized by small, nodule-like growths on the skin with striking bright red to blue-red discoloration. The skin nodules, also known as pseudolymphomas, result from immigration of B and T lymphocytes from the lymphatic system. The small growths are soft, bulging and usually spherical. Borrelia lymphocytomas typically occur preferentially on the face, neck, earlobes, nipples, and genital area on the scrotum. It is striking that predominantly children, adolescents and women are affected. Differentiation from malignant B-cell lymphomas can be made by determining the cell type of the B lymphocytes present in the nodules. B lymphocytes of Borrelia lymphocytomas are of multiclonal origin, i.e. originate from different cell lineages, whereas the B lymphocytes in malignant B cell lymphomas each originate from a single cell lineage. Therefore, they are of monoclonal origin.
Causes
One of the main causes for the development of Borrelia lymphocytomas is Lyme disease. The infectious disease was named after the town of Lyme in Connecticut, USA. It is an infection with bacteria of the genus Borrelia from the group of spirochetes, helical, gram-negative bacteria with their own characteristic locomotor system. In Central Europe, the trigger of Lyme disease is usually the bacterium Borrelia afzelli or related species. The pathogens are transmitted by bites of infected shield ticks. But only about one-third of illnesses are caused by Borrelia. Viral infections are also held partially responsible for the occurrence of benign Borrelia lymphocytomas. In the majority of cases in which neither a Borrelia nor a viral infection can be detected, the causative agent of the disease is unknown.
Symptoms, complaints, and signs
Benign Borrelia lymphocytomas are most noticeable by their striking appearance. The spherical bright red to blue-red swellings range in size from several millimeters to a few centimeters and, if they appear in exposed areas, are hard to miss. In cases where the soft nodules are caused by a Borrelia infection, further symptoms appear as concomitants. Already in the early phase, before the formation of visible lymphocytomas, non-specific complaints such as headache and pain in the limbs, neck stiffness and a general feeling of malaise are characteristic. The symptoms are thus similar to those of influenza. Typical for the manifestation of Borrelia lymphocytoma is also the development of a ring-shaped migratory redness (erythema migrans). It presents as a gradually outwardly migrating concentric red strip of skin that forms at the site of injection. Although erythema is a typical accompanying symptom, it does not occur in all cases of Borrelia infection.
Diagnosis and course
Borrelia lymphocytes are easy to recognize because of their conspicuous appearance. However, their appearance does not tell us anything about their causative agent, which is ultimately what therapy will be based on. When one or more of the typical nodules first appear, it should be clarified whether a tick bite occurred a short or even longer time before. If this was the case, the suspicion of a Borrelia infection is obvious. The suspicion can be clarified by laboratory tests and general symptoms. Furthermore, a differential diagnosis should exclude that the nodules are not malignant lymphomas, which require a completely different therapy. The course of the disease in the presence of Borrelia lymphocytes depends exclusively on the course of the underlying disease. In the case of a Borrelia infection, the disease can be very severe due to a possible multi-organ infestation.
Complications
Borrelia lymphocytoma forms a blue-red swelling in the form of a soft nodule. The clearly visible symptom is a cellular reaction of the blood and is thought to result from a tick bite. Not everyone is prone to such symptoms, as sufficient antibodies are present. However, those who belong to the risk group and do not have the Borrelia lymphocytoma treated in time must expect unpleasant complications. If the Borrelia bacteria begin to spread throughout the body, they can affect the entire immune system as well as the organs, muscles and joints. Compared to America, however, there are fewer chronic cases in Europe. Especially children who play a lot in forest and meadow areas should be regularly examined on the body for the noticeable signs. Significant late effects of the untreated pathogens are various symptomatic relapses where the affected patient suffers from fatigue, fibromyalgia, nerve damage, joint pain and organ dysfunction. If the course is chronic, therapy can hardly alleviate the named late effects. Permanent damage to the skin, cartilage and joints, mostly elbows and knees, persists. In older patients, this can manifest itself in the form of arthritis. Adults tend to have dysfunction of the thyroid gland and nervous and connective tissues. If lymphocytoma is detected in time, the chances of recovery tend to be uncomplicated.
When should you see a doctor?
In about one-third of all cases, the soft, reddish nodules are due to infection with Borrelia bacteria and are signs of Lyme disease. Affected people should therefore go to the doctor at the latest when the nodules become visible. Since the severity of the course of Lyme disease and possible late effects are all the worse the later the disease is recognized and treated, patients had better react as early as possible. After a tick bite, it is helpful to first become familiar with the symptoms of Lyme disease and early onset meningoencephalitis. An incipient Lyme disease is noticeable by accompanying symptoms that are very similar to those of influenza. Typical symptoms are severe headache and pain in the limbs, fever, general malaise and stiff neck. After a tick bite or a stay in a risk area, affected persons should immediately consult a doctor when these symptoms appear and explicitly mention the possibility of Lyme disease. An immediate visit to the doctor is also necessary if the so-called wandering redness (erythema migrans) appears. This is a circular, steadily increasing redness that usually forms around the bite site, but can also occur on another part of the body. Migratory redness is one of the few characteristic features of Lyme disease infection. In these cases, immediate treatment with antibiotics is indicated. Unless a Lyme lymphocytoma is due to infection with Borrelia, it is usually harmless, but a physician should still be consulted as a precaution.
Treatment and therapy
Treatment of Lyme lymphocytosis attributable to Lyme disease is primarily aimed at combating the causative bacteria. Depending on the severity of the disease, there are various antibiotics to choose from, which can also be used in an individual combination. Since the bacteria are difficult to fight, the antibiotics must be taken strictly as directed over a prolonged period of several weeks. In addition, no medications should be taken that can reduce the effectiveness of the specific antibiotics. Additional therapies to strengthen the immune system are beneficial. Even after seemingly successful therapy, the disease may flare up again because the Borrelia bacteria were not completely rendered harmless by the treatment with antibiotics. If the causative agent of the Borrelia lymphocytes cannot be determined and a bacterial infection can be ruled out, the use of antibiotics “on suspicion” is not recommended. Assuming that the other typical general symptoms of Lyme disease do not occur either, the treatment of red nodules aims at strengthening and modulating the immune system. This also includes a lifestyle that, in addition to stress phases, also gives room for short phases of relaxation and regeneration.Phases of tension controlled by the sympathetic nervous system (stress hormones) should be allowed to alternate with parasympathetically controlled phases.
Outlook and prognosis
The actual Borrelia lymphocytoma is a symptom of Lyme disease and can only be considered in connection with this infection. In this case, it always occurs together with erythema chronicum migrans, which is a reddening of the skin after a tick bite. Other forms of Borrelia lymphocytoma are caused by viruses, although this is not the same disease, but only a similar appearance. In all cases, hyperplasia of lymphoid cells takes place. Frequently, the disease is observed in children and adolescents, as well as in women aged 40 to 70 years. Most often, Borrelia lymphocytoma appears in stage I of a Borrelia infection. In rare cases, it may also appear in the second stage of Lyme disease. Overall, although it represents a symptom of Lyme disease, it does not occur very frequently even in the context of this disease. Rather, Borrelia lymphocytoma is considered a special case of a Borrelia infection. In case of an early treatment with antibiotics, the borrelia can still be fought completely. If no treatment is given or if the treatment is too late, the infection spreads and manifold symptoms such as Lyme arthritis or neurological disorders with polyneuropathy, meningitis, encephalomyelitis or encephalitis occur. Furthermore, chronic diseases of the sensory organs, joints or muscles may also occur. However, the symptomatology is individual for each affected person. In the late stages of the disease, a complete cure is often no longer possible.
Prevention
Preventive measures are mainly limited to protecting oneself from tick bites, especially in areas at risk where Lyme disease is known to have already occurred. Good protection is found in wearing long pants and long-sleeved shirts that have cuffs that close off if possible. Additionally or alternatively, after spending time in areas where ticks are present, carefully inspect the skin all over the body for possible tick infestation and remove possible ticks with tick forceps or tweezers. There is no risk of infection until many hours after the tick has “burrowed” into the skin.
Aftercare
As a rule, no special aftercare options are available to the affected person with a Borrelia lymphocytoma. The patient must rely on symptomatic treatment of this disease to avoid further complications. In most cases, antibiotics are used to alleviate the symptoms. The patient must also ensure that the antibiotics are taken regularly. Interactions with other medications should also be discussed with a doctor. When taking antibiotics, alcohol should also be avoided permanently. In general, a healthy diet and a healthy lifestyle also have a very positive effect on the further course of the disease. The immune system of the affected person must also be particularly protected in this disease in order to avoid further illnesses. Stress should also be avoided as far as possible. If possible, strenuous activities or sports should be avoided. When saddling up in predestined areas, the patient should protect himself against ticks if possible and wear long clothing. Likewise, repellent sprays can prevent the infestation. It is not possible to predict in general whether there will be a reduced life expectancy as a result of Borrelia lymphocytoma. In some cases, contact with others affected by the disease can also be useful, as this can lead to an exchange of information.
Here’s what you can do yourself
Since Borrelia lymphocytoma is a concomitant of Lyme disease, which is transmitted by tick bites, the best form of self-help is to avoid tick bites or to treat them adequately in a timely manner. People who spend a lot of time outdoors should first check the risk of Lyme disease for their region as well as for their vacation spot, if applicable. Corresponding overview maps are provided free of charge on the Internet. The risk of a tick bite is particularly high when hiking or playing on meadows and in tall grass or when coming into contact with low trees and bushes. Ticks also particularly like to stay in wet areas. Particular caution is therefore advised around bodies of water.The Lyme disease pathogens are transmitted by the insects during the exchange of body fluids with the host. The longer a bitten tick remains undetected, the greater the risk of infection. Bitten ticks should therefore be removed promptly and preferably by a physician. Strengthening the immune system can also prevent a possible outbreak of Lyme disease or at least reduce the severity of the disease. In particular, a healthy diet rich in vitamins, regular physical exercise in the fresh air, as well as sufficient sleep and abstaining from excessive consumption of alcohol and nicotine contribute to strengthening the immune system.
