Dr. Murai Éva szerk.: Parasitologia Hungarica 24. (Budapest, 1991)

fluctuating course during a year in some untreated cases. The lesion develops from a small papule at the site of tick bite (Photo 2-6). In our cases, the longest diameter of the slowly enlarging ring was 90 centimetres, the shortest 5 centimetres. Occasionally the erythema was accompanied by burning sensation or mild pain. Sixty-one out of 519 patients complained of definite general symptoms: myalgia, headache, malaise. Only six had fever above 38°C. Two-thirds of the ECM cases had no other symptom. Multiple ECM rings were observed in 16 of the 131 (12.2%) personally examined ECM patients. In those cases the skin lesion developed not only at the site of tick bite but in different areas of the body. Lymphadenosis benigna cutis (LBC). LBC is a solitary tumour-like skin lesion. Nevertheless, by histological examination a benign lympho-plasmocytic infiltration is detected. LBC prefers the two coldest parts of the body: usually one of the nipples or ear lobes are involved. In all of our eight patients, the skin lesion was seen at the latter site. It was often accompanied by a bluish or reddish discolouration at the edge of the external ear. If ECM had preceded the LBC the ear was always involved at the same site. Similarly, all the noticed tick bite were close to the ear. In one patient, ipsilateral facial palsy was also seen. Five of the eight cases were seropositive. Acrodermatitis chronica atrophicans (ACA). This unusual manifestation of Lb was diagnosed in 16 patients. The first signs were aspecific: bluish-red or cyanotic infiltration with pasty consistency on the distal parts of limbs, particularly on the extensor surfaces. Although the disorder usually appeared on both hands or both feet, it was never strictly symmetrical. If ACA was preceded by ECM, the latter had always involved the same region where ACA developed later. The involved skin gradually thinned, decolourated and wasted, while the inflammation spread on the edges, often in spots. Almost all of the patients had small joint arthritis in the region of ACA (84). Three patients had problems after antibiotic treatment: they had to buy new shoes because their feet became smaller again. Carditis Eighteen cases of Lyme carditis were diagnosed. Rhythm disturbances were the principal signs in all of them. Fluctuating tachycardia was registered by ECG in six, otherwise healthy patients. Repeated ventricular or supraventricular extrasystole was found in two cases. Atrioventricular block was the most typical sign of Lyme carditis: 1st, 2nd and 3rd degree AV block was seen in nine, two and three cases, respectively. The latter three required temporary pacemaker treatment (87, 88). Moderate cardiomegaly and mild pericardial effusion were demonstrated by echocardiography in one case only. Moreover nine seropositive and/or ECM cases had cardiac pain or palpitation, but ECG did not reveal any abnormality. These cases were not enrolled into this group. Spontaneous improvement of carditis was seen in 13 cases, but subsequently facial palsy developed in one and gonarthritis in another patient.