Erythema Migrans in Patients with Post-Traumatic Splenectomy

TL;DR

This study found that patients without a spleen due to trauma have different symptoms and higher treatment failure rates for Lyme disease-related erythema migrans compared to those with a spleen.

Contribution

The study is the first to compare clinical features and treatment outcomes of erythema migrans in splenectomized versus non-splenectomized adults with Lyme borreliosis.

Findings

Splenectomized patients had shorter EM duration before diagnosis and smaller EM diameter compared to non-splenectomized patients.

Treatment failure occurred in 19.2% of EM episodes in splenectomized patients versus 0% in non-splenectomized patients.

All treatment failures in splenectomized patients resolved after retreatment with standard antibiotic regimens.

Abstract

Information on asplenic Lyme borreliosis (LB) patients with erythema migrans (EM) is lacking. We compared the course and outcome of 26 EM episodes in 24 post-trauma splenectomized patients (median age 51 years) diagnosed at a single clinical center in Slovenia during 1994–2023 with those of 52 age- and sex-matched patients with EM but with no history of splenectomy. All patients were followed for one year. A comparison of pre-treatment characteristics revealed that EM in splenectomized patients was of shorter duration before diagnosis (4 vs. 8 days, p = 0.034) with a smaller EM diameter (10.5 vs. 14 cm, p = 0.046), and more frequently fulfilled criteria for disseminated LB (3/26, 11.5% vs. 0%, p = 0.034). Treatment failure occurred in 5/26 (19.2%) EM episodes in splenectomized patients versus 0/52 in non-splenectomized patients (p = 0.003). The five treatment failure cases were retreated with antibiotic regimens used to treat EM and had complete resolution of all symptoms/signs. In conclusion, our study showed that splenectomized adult patients with EM differ somewhat in presentation and more often have treatment failure compared with non-splenectomized patients with EM.

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