Lyme lymphocytoma or malignant lymphoma - differential diagnosis is important 
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 Lyme lymphocytoma or malignant lymphoma - differential diagnosis is important

Lymphoma is mentioned in the differential diagnosis of the 1st article--the
differential diagnosis is only as good as the info the doctor has--it is
obvious many doctors don't have correct info on Lyme and are not going to get
it from the so called "experts".  If the doctor doesn't
know that Lyme MUST  be included in the differential diagnosis....you decide

"..... The most important alternative diagnosis for such lymphocytomas are
malignant lymphoma.."

from:  California Lyme Disease Symposium 1994
Lyme Disease Resource Center of California
reported by Jean Hubbard

"Dermatologic Manifestations of Lyme Disease------

"Dermatologist Rudy Scrimenti, the first physician to identify EM in the United
States, noted that cutaneous manifestations of Lyme disease have served as
hallmarks of the disease., but agreed with Dr. Katzel  that 'the classical
lesion with central clearing and red bands, although most diagnosable and most
readily recognizable, is far from being the most common lesion of EM, with
triangular lesions being quite common..'  .....There is another lesion with
varieagated redness throughout, but in the central portion there are blisters
or vesicles.  Sometimes these become crusted and highly inflammed.  When
inflammatory changes occur in EM they are always focally placed in the central
portion and not throughout the lesion.  They will eventually scale, but scaling
occurs only in the center and is not a particularly consipicuous feature at the
peripheral margins.  90% of the cultures are negative in such lesions, and one
of athe reasons is that some of the inflammatory lesions probably show a
hypersensitivity  reaction to the tick parts, possibly to the tick salivary
gland substances......
"There are Lyme disease rashes of sorts not yet documented well in the United
States, but present in Europe.  These include a reddened {*filter*} {*filter*} areola,
which is a Lyme borrelial lymphocytoma:  this is the most common location in
{*filter*}s, males and females.  The most common site in children is the lobe of the
ears.; thus far this has not been successfully cultured in the United States. "
(this might have changed at this time) " Coalescent papules on the entire rim
of the auricle are also compatible with lymphocytoma.  There are also
lymphocytomas that remain, sometimes for years, after the more  typical EM rash
resorbs;  these do improve with tetracycline and I am SURE I HAVE SEEN THESE IN
MY PRACTICE IN WISCONSIN,  but thus far I've been unable to obtain a positive
culture.  The most important alternative diagnosis for such lymphocytomas are
malignant lymphoma........"
______________________
From Brain (1992), 115, 399-423
The Clinical and Epidemiological Profile of Lyme Neuroborreliosis in
Denmark 1985-1990
  A prospective study of 187 patients with Borrelia burgdorferi specific
intrathecal antibody production
by Klaus Hanson and Anne-Mette Lebech  (from the Borrelia Laboratory,
Department of Infection-Immunology, Statens Seruminstitut, Copenhagen, Denmark)

from page 406:  "Painful sensory radiculitis:  
   " Radiculitic pain was a major symptom and present in 160
patients....The intensity of radicular pain increased significantly with
the age of the individual..The onset was in most instances subacute,
occurring overnight.  Pain often began in the region of a previous erythema
migrans, then migrated and finally became most pronounced axially in the
back typically between the shoulder blades but also in the neck or lumbar
region.  Some patients had migrating pain almost over the whole body.  The
pain was described as being of a type never experienced before and was
easily distinguished from ordinary back pains. The intensity of the pain often
varied
from day to day and typically showed severe nocturnal exacerbations
......Pain was described by most patients as severe, burning deep and/or
superficial as if located in the skin, and often accompanied by patchy
areas of unpleasant hyper- and dysaesthesiae .   Occasionally a belt-like
sensation around the trunk was described.  Severe pain was refractory to
morphine.  Forty-six patients had radiculitic pain only and never developed
focal motor signs.  In 54 patients the sensory radiculitis either
diminished or disappeared even before therapy after 2-16 weeks.
    Before the final diagnosis of neuroborreliosis was established, the
painful condition was often thought to be due to other diseases, e.g.herpes
zoster neuralgia, cervical or lumbar nerve root compression, facet
syndrome, brachial plexus neuropathy, polymyalgia rheumatica, myocardial
infarction or kidney concrements (stones).  In one female a cholesystectomy
(gall bladder removal) was performed , three patients underwent biopsy of
the temp{*filter*}lobe , three and i.v. pyelogram (radiograph of the ureter and
renal pelvis), seven a bone scintigraphy and 17 a myelogram , before the
final diagnosis .  Routine examination of the CSF obtained during the
myelography unexpectedly revealed pleocytosis leading to the correct diagnosis.
   " Some patients presented with an agitated mental state.  This was
probably due to severe pain condition and deprivation of sleep for days to
weeks.  Thir{*filter*} patients were initially suspected of being hysterical and
several were examined by a psychiatrist because of the apparent
diproportion between thier dramatic complaints and the lack of signs of the
disease.
....Two had paresis of the abdominal wall.  The distribution of paretic
muscles usually indicated involvement of multiple nerve roots.  Tendon
reflexes were attenuated or absent only corresponding to the muscle
weakness.........spastic bladder paresis.....clinical signs of meningitis
are  remarkably rare....
    "We conclude that neuroborreliosis is a common, clinically
characteristic but still underrecognized neurological syndrome.
.....differential diagnosis:  Guillain-Barre syndrome, herpes zoster
radiculitis, lymphocytic meningitis of other aetiologies, meningeal
carcinomatosis (widespread dissemination of carcinoma in the body), CNS
lymphoma, sarcoidosis, multiple sclerosis and other encephalopathies."

TITLE: Infection by Borrelia burgdorferi and cutaneous B-cell lymphoma
.AUTHOR: Cerroni L; Zochling N; Putz B; Kerl H
AUTHOR AFFILIATION: Department of Dermatology, University of Graz, Austria
.SOURCE: J Cutan Pathol 1997 Sep;24(8):457-61NLM CIT. ID: 97472931
ABSTRACT: In past years, association of primary cutaneous B-cell lymphoma
(CBCL) with infection by Borrelia burgdorferi has been reported in a few
patients. The evidence for a pathogenetic role was based on clinical grounds or
raised titre of antibodies in serum. Both methods, however, do not prove the
association between the micro-organism and the CBCL, especially 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 pattern of immunoglobulin light chains or molecular analysis
of JH gene rearrangement, or both. Specific DNA sequences of Borrelia
burgdorferi were identified in cutaneous lesions from 9 patients (follicle
center lymphoma: 3/20; immunocytoma: 3/4; marginal zone B-cell lymphoma: 2/20;
diffuse large B-cell lymphoma: 1/6). Specificity was confirmed by Southern blot
hybridisation in all positive cases. We could show that Borrelia burgdorferi
DNA is present in skin lesions from a small proportion of patients (18%) with
various types of CBCL. Our results may have therapeutic implications. In
analogy to Helicobacter pylori-associated MALT-lymphomas, which in some cases
can be cured by eradication of Helicobacter pylori infection, a proportion of
CBCL may be cured with antibiotic therapy against Borrelia burgdorferi.
Although yet speculative, adequate antibiotic treatment for patients with
primary CBCL should be considered before more aggressive therapeutic options
are applied, particularly in countries where infection by Borrelia burgdorferi
is endemic. PCR analysis of Borrelia burgdorferi DNA is a fast test that should
be performed in all patients with CBCL to identify those who more likely could
benefit from an early antibiotic treatment

Subject:      Lyme disease meningopolyneuritis simulating malignant lymphoma
Date:         1997/12/14
authors:  Szyfelbein WM, et al
title:  Lyme disease meningopolyneuritis simulating malignant lymphoma
source:  Mod Pathol 1988 Nov;1(6):464-8

Abstract:  Lyme disease is a multisystem disorder resulting from infection by
the tick-borne spirochete, Borrelia burgdorferi.  Fever, chills and headaches;
a characteristic rash;  and subsequent polyarthritis typically herald the onset
of this condition.  Neurologic involvement may occur with skin and joint
manifestations or present alone as meningitis, cranial neuritis, and
radiculopathy known as Bannwarth's syndrome.  We report the cerebrospinal fluid
(CSF) cytomorphologic and immunocytochemical features of four patients who
presented with isolated meningitis, cranial neuritis, and painful neuropathy
without initial history of specific skin rash or previous tick bite.  Initial
CSF findings of significant numbers of markedly atypical plasmacytoid
mononuclear cells suggested CSF non-Hodgkins malignant lymphoma.
Immunocytochemical studies on CSF specimens, however, revealed polyclonal
surface immunoglobulin patterns consistent with an inflammatory reaction.
Follow-up clinical history and/or peripheral {*filter*} serologic testing for
antibody titers with B. burgtdorferi antigen confirmed the diagnosis of Lyme
disease in all four cases.  We conclude that Lyme disease may present as
atypical spinal fluid lymphoplasmacytic cellular infiltrates that simulate
malignant lymphoma and that appropriate immunocytochemical studies and
peripheral {*filter*} serologic testing be performed to establish this diagnosis and
direct appropriate therapy.

Address:  Department of Pathology, Harvard Medical School, Boston,
Massachusetts.

from :  Clinical Manifestations of Lyme Disease in the United States
authors:  Trock, et al  (Yale University School of Medicine, New Haven, CT.)
source:  Connecticut Medicine, June 1989  Volume 53,  NO. 6  pg. 327-30

.............."Borrelia Lymphocytoma"
    "A rare early cutaneous manifestation of Lyme disease is borrelia
lymphocytoma, a tumor-like violaceous swelling or nodule at the base of the
earlobe or the {*filter*} caused by a dense lymphocytic infiltrate of the dermis.
This lesion occurs at the site of a tick bite, is usually solitary, and may be
associated with regional lymphadenopathy.  In the setting of fever, fatigue,
and adenopathy, borrelia lymphocytoma can be confused with a lymphoma.
Untreated, this lesion may linger for 6-12 months before it disappears
spontaneously......"
  "An interesting and diagnostically useful rheumatic symptom in
early Lyme dsease is temporomandibular joint pain, which is only rarely
seen in other rheumatic disorders.  Months to years after erythema
migrans, 60% of untreated patients will develope joint manifestations
ranging from migratory arthralgias to chronic destructive
arthritis....;Baker cysts are common."
       Of babies born to mothers that were asymptomatic but had positive
serologies for Lyme  the authors say " The development of these infants
warrants further observation, especially since in another spirochetal
infection, con{*filter*} syphilis, abnormalities are not always evident at
birth.....

Here is a summary of  "The Merck Manual--Malignant Lymphomas:  Non-Hodgkin's
Lymphoma"---"Summary:  Clinical staging procedures similar to those for
Hodgkin's disease (see above) are indicated, except that laparotomy and
spenectomy are rarely required.  THE FINAL STAGING IS MORE OFTEN BASED UPON
CLINICAL FINDINGS  than is the case in Hodgkin's disease, in which pathologic
stage is critical for management decisions." My question---If a doctor
thinks Lyme is a rare disease due to using some of the self designated "lyme
experts" as their  sources of info.-- can a doctor confuse Lyme with
non-Hodgkin's Lymphoma?  How will doctors know that Lyme may be in the
differential diagnosis of this type of lymphoma?  If you think something is
rare and don't even know it's different manifestations--in this particular
situation---what happens?  The doctor has to know to rule out possible Lyme.

  This is an article that appeared in the health section of Vogue magazine in
Dec. of 1996--"Cancer conundrum:  Non-Hodgkin's lymphoma has increased about
75%  over the past 25 years--and doctors aren't sure why.  Both AIDS and organ
transplant patients are susceptible to non-Hodgkin's lymphoma, and these two
groups are growing.  Yet they account for only a small part of the increase.
Some physicians believe that exposure to agricultural herbicides and pesticides
may play a role.  The good news is, while survival rates were once low, now up
to half of patients with lymphoma are cured or go into remission for many
years."

This is from a Miami Herald article I got from the Miami Herald Medical Reports
on line.  It is from Sept.  1994  "Non-Hodgkin's  Lymphoma :  What you should
know-----.....The incidence of non-Hodgkin's lymphoma has increased in the past
few years.  Carlos Dominguez, M.D., an oncologist at Mount Sinai's
Comprehensive Cancer Center, says .......'For example, currently we're finding
in women age 20 to 30 a type of lymphoma that is confined to the chest and
initially manifests itself as a persistent cough or chest discomfort,' "
 "..'in addition, much attention is now being paid to a
non-Hodgkin's lymphoma that starts in the stomach, causing non-specific
symptoms of dyspepsia.  ' This particular lymphoma is notable because of its
association with a bacteria that is commonly found in the stomach.  This is the
first time bacteria has been implicated as a cause of lymphoma, ' Dominguez
notes.  'The eradication of the bacteria with antibiotics can result in a cure
for lymphoma.........' "
?????

I have another reference.  It is for sypillis but close enough since
they have done so little research in this area for Lyme.

Gastric syphillis:  endoscopic and histological features mimicking
lymphoma.  (Am J Gastroenterol 1995;90:1504-1507)(Abstract) by Billy W.
Long v274
JAMA< The Journal of the American Medical Association Dec 13 1995
p.1745(1)--"....Gastroenterologists and pathologists must have an
awareness that gastric syphillis can mimic lymphocitic gastritis and
gastric lymphoma ....gastric syphillis must be carefully considered as
adiagnostic possibiolity in any patient with endoscopic and histological
findings suggesting lymphocitic gastritis or lymphoma.  The diagnosis of
gastric syphillis should be weighed even when H.Pylori infection is
present..."
Gastric involvement in syphillis. ( Tips froom other journals)  v46
American Family Physician August  1992 p552(1).....The most common
clinical manifestations of gastric syphilis were abdominal pain, vomiting
and weight loss......
    I have not read about one thing that syphilis caused that I haven't
heard one of the real experts, the patients,  say they have experienced
with Lyme.  

Gastrointestinal pathology in children with Lyme disease
Martin D. Fried, MD; Paul H. Duray, MD; and Dorothy Pietrucha, MD.  JSTD  1996;
3:101-104.

Ten children between the ages of 8 and 19 with Lyme disease presented with
chronic gastrointestinal symptoms. Biopsy evidence of inflammation was found in
the stomach, duodenum, and colon. Pathologies included gastritis, duodenitis,
gastric ulcer, colitis, and a histopathology resembling Crohn's disease.
Spirochetes with the microscopic appearance of Borrelia were found in five
patients with chronic inflammatory conditions of the gastrointestinal tract.
The inflammation may have been due to the spirochete itself, a reactive product
related to their presence in the gastroin testinal tract, or a consequence of
medications used to treat Lyme disease.
?????????? JSTD 1996; Volume 3, Number 3/4 (Fall/Winter)



Tue, 15 Feb 2005 07:06:57 GMT
 
 [ 1 post ] 

 Relevant Pages 

1. pt 1 Non-Hodgkins Lymphoma or Lyme - differential diagnosis not easy

2. pt 2 Non-Hodgkins Lymphoma or Lyme - differential diagnosis not easy

3. diagnosis-malignant lymphoma-changed to syphilis

4. Lyme Disease - Differential Diagnosis??

5. Lyme disease can mimic malignant lymphoma

6. Can Lyme disease simulate malignant lymphoma? Yes

7. Pain,Hysteria,Differential diagnosis and Lyme

8. Lyme disease meningopolyneuritis simulating malignant lymphoma

9. Lyme disease meningopolyneuritis simulating malignant lymphoma

10. Differential diagnosis of bradycardia should include Lyme carditis (NEJM correspondence)

11. Lyme simulating malignant lymphoma

12. Differential Diagnosis for Lyme Disease: hemochromatosis


 
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