Pityriasis lichenoides-like lesions with perifolliculitis in Lyme borreliosis

A 13-year-old girl presented cutaneous lesions reminiscent of pityriasis lichenoides, associated with headache and fever. The clinical features raised the suspicion of Lyme borreliosis due to their occurrence three months after a trip in an endemic area. The diagnosis of Lyme borreliosis was confirmed by the demonstration of spirochete-like bodies inside the lesions with Warthin-Starry silver stain and by identifying B. burgdorferi flagellar genoma in the affected skin with polymerase-chain reaction. The authors discussed the diagnosis, prognosis and therapy of this unique case of Lyme borreliosis.