Follicular Borreliosis: An Atypical Presentation of Erythema Chronicum Migrans
Bibliographic record
Abstract
Lyme serology was positive for both IgG and IgM (ELISA, Enzygnost Borreliosis , Siemens, Dade Behring, Germany, and blot, Euroline WB , Euroimmun, Germany). A punch biopsy of a papule showed a dermal perifollicular ( fig. 2 ) – and occasionnally perineural – infiltrate of lymphocytes and plasma cells, consistent with a borrelial infection. Borrelia burgdorferi DNA was amplified from fresh tissue obtained from a skin biopsy performed on a peripilar papule, using a specific real-time PCR according to Makinen et al. [1] (culture not performed). The erythema resolved after a 3-week doxycycline treatment whereas arthralgia and dysesthesia persisted. Erythema chronicum migrans (ECM) is usually the earliest manifestation of Lyme borreliosis. It occurs a few days, sometimes a few weeks, after the tick bite. Lyme disease is caused by an infection with the spirochete B. burgdorferi, which is transmitted by ixodid ticks. ECM usually begins as a macule or papule at the site of the tick bite and evolves as a centrifugally growing annular erythematous plaque with central clearing. It is usually asymptomatic, but localized pruritus, pain, hyperesthesia or dysesthesia have occasionally been reported [2] . It spontaneously disappears within several weeks, occasionally several months; antibiotherapy shortens the evolution and prevents secondary dissemination which can cause neurological, rheumatological, cardiac, ophthalmological and late cutaneous complications [3] . Posttreatment assessment is clinical [4] . Numerous atypical presentations have been described for ECM: mini erythema migrans [5] , erythema with no central clearing, erythema with central induration [6] , vesicles [7] , ulceration, necrosis or purpura [1] , alternating bands of erythema, confluent red or red-blue lesion without central clearing, and even triangular, rectangular or linear lesion [6, 8] .
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".