Patients with Lyme disease may present with a variety of genital lesions and dermatologic manifestations including Morgellons disease, researchers reported in a study published in Clinical, Cosmetic and Investigational Dermatology.
The investigators described their findings in a 49-year-old woman who presented with vaginal itching of several weeks’ duration in early March 2015. Examination revealed an external vaginal and vulvar papular red rash, as well as skin loss, hypopigmentation, cracks, and ulceration in an area surrounding the vagina. She was treated with oral fluconazole for 3 days. Testing was positive for herpes simplex virus type 1, and she was treated with valacyclovir.
In June 2015, she developed ulcerated, punctate erosions with ragged edges on her back. Serologic and PCR testing demonstrated that antibodies to Borrelia burgdorferi sensu lato (Bbsl) and Relapsing Fever Borrelia (RFB) species and B burgdorferi DNA were detected. Vaginal Borrelia culture samples were sent for B burgdorferi PCR testing, and positive results were shown for Bbsl genes.
By December 2017, the patient’s skin condition and other symptoms had worsened, it was noted. Repeat serologic testing was negative for Ehrlichia chaffeensis but was positive for B burgdorferi, Babesia duncani, and Bartonella henselae.
In December 2018, after the patient’s antibiotic treatment was discontinued, she relapsed and developed annular rashes on her hands, legs, back, and abdomen. Microscopic examination revealed embedded blue fibers consistent with Morgellons disease.
Gömöri trichrome staining demonstrated that the fibers contained collagen, and Dieterle staining showed bacterial aggregates within the hyperkeratotic stratum corneum with long extracellular spirochetes and intracellular organisms among the keratinocytes in the stratum basale.
Positively stained Borrelia organisms consistent with cystic morphology were observed within many of the bacterial aggregates. Gram staining showed Gram-positive cocci on the superficial stratum corneum and in bacterial aggregates within the hyperkeratotic stratum corneum. Gram-positive organisms were not found in the deeper layers of the epidermis and dermis. According to the investigators, these findings indicated that Borrelia organisms were present in mixed-bacterial aggregates and intra- and extracellularly among the keratinocytes of the stratum basale.
The patient is currently receiving a cycling maintenance regimen of tinidazole and trimethoprim/sulfamethoxazole.
“If skin lesions contain fibers, the diagnosis of Morgellons disease should be considered and testing for tickborne disease should be undertaken,” the study authors advised. “Relapsing Fever Borrelia and tickborne co-infections are being recognized more frequently in association with dermatologic manifestations, and it is important to consider these emerging infections to ensure optimal treatment and patient improvement.”
Disclosures: One of the study authors declared an affiliation with a medical laboratory, another is the owner of a medical group practice, and 2 are owners of a US patent pertaining to Lyme disease. Please see the original reference for a full list of disclosures.
Middelveen MJ, Haggblad JS, Lewis J, et al. Dermatological and genital manifestations of Lyme disease including Morgellons disease. Clin Cosmet Investig Dermatol. 2021;14:425-436. doi:10.2147/CCID.S299526