Summary
Borrelial lymphocytoma is a rare cutaneous manifestation of early localized European Lyme borreliosis. It manifests as a nodule or plaque with a diameter of up to a few centimeters. The lesion is, as a rule, solitary. It is more common in children than in adults and, in contrast to erythema migrans and acrodermatitis chronica atrophicans, has male predominance. A tick bite has been reported in approximately one half of patients; the tick bite is usually at the site or in the vicinity of the later borrelial lymphocytoma. The predilection site for the development of lesions is the breast in adults and the ear lobe in children. Borrelial lymphocytoma is frequently associated with erythema migrans, but rarely with other manifestations of Lyme borreliosis, and is predominantly caused by Borrelia afzelii. At presentation, approximately half of the patients with borrelial lymphocytoma have measurable serum borrelial antibodies and, in about one third, spirochetes can be cultivated from the skin lesion. A 14-day antibiotic therapy, as recommended for patients with erythema migrans, is highly successful. Posttreatment duration of a borrelial lymphocytoma is positively associated with the pretreatment duration of the lesion and with patient age, while treatment failure is associated with the clinical signs of disseminated Lyme borreliosis at presentation. Substantial improvements in knowledge on borrelial lymphocytoma and laboratory diagnostics in recent decades have contributed to earlier diagnosis and treatment. Consequently, borrelial lymphocytoma is usually a mild disease with a good prognosis.
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References
Spiegler E. Über die sogenannte Sarcomatosis cutis. Arch Dermatol Syph. 1884;27:163–74.
Fendt H. Beiträge zur Kenntnis der sogenannten sarcoiden Geschwülste der Haut. Arch Dermatol Syph. 1900;53:2013–42.
Burckhardt JL. Zur Frage der Follikel-und Keimzentrenbildung in der Haut. Frankf Z Pathol. 1911;6:352–9.
Strandberg J. Regarding an unusual form of migratory erythema caused by tick bites. Acta Derm Venereol. 1920;1:422–7.
Kaufmann-Wolf M. Über gutartige lymphocytäre Neubildungen der Scrotalhaut des Kindes. Arch Dermatol Syph. 1921;130:425–39.
Bäfverstedt B. Über Lymphadenosis benigna cutis. Acta Derm Venereol. 1943;24(Suppl 11):1–202.
Bianchi GE. Die Penicillinbehandlung der Lymphocytome. Dermatologica. 1950;100(4–6):270–3. [Penicillin therapy of lymphocytoma].
Paschoud JM. Die Lymphadenosis benigna cutis als übertragbare Infektionskrankheit. Hautarzt. 1957;8(5):197–211. [Lymphadenosis benigna cutis as a communicable infectious disease; new viewpoints on its course, histology and therapy].
Paschoud JM. Die Lymphadenosis benigna cutis als übertragbare Infektionskrankheit. Hautarzt. 1958;9(4):153–65. [Lymphadenosis benigna cutis as a communicable infectious disease. II. Transmission to the skin of the body].
Paschoud JM. Die Lymphadenosis benigna cutis als übertragbare Infektionskrankheit. Hautarzt. 1958;9(6):263–9. [Lymphadenosis benigna cutis as a communicable infectious disease].
Paschoud JM. Die Lymphadenosis benigna cutis als übertragbare Infektionskrankheit. Hautarzt. 1958;9(7):311–5. [Lymphadenosis benigna cutis as a communicable infectious disease].
Burgdorfer W, Barbour AG, Hayes SF, et al. Lyme disease—a tick-borne spirochetosis? Science. 1982;216(4552):1317–9. https://doi.org/10.1126/science.7043737.
Weber K, Schierz G, Wilske B, et al. European erythema migrans disease and related disorders. Yale J Biol Med. 1984;57(4):463–71.
Wilske B, Schierz G, Preac-Mursic V, et al. Serologic diagnosis of erythema migrans disease and related disorders. Infection. 1984;12(5):331–7. https://doi.org/10.1007/BF01651147.
Frithz A, Lagerholm B. Acrodermatitis chronica atrophicans, Erythema chronicum migrans, and Lymphadenosis benigna cutis—spirochetal disease? Acta Derm Venereol. 1983;63:432–6.
Neubert U. Zur Ätiologie von Erythema-migrans-Krankheit und Lyme-Erkrankung. Hautarzt. 1984;35(11):563–70. [Etiology of erythema migrans disease and Lyme disease].
Steere AC, Grodzicki RL, Kornblatt AN, et al. The spirochetal etiology of Lyme disease. N Engl J Med. 1983;308(13):733–40. https://doi.org/10.1056/NEJM198303313081301.
Benach JL, Bosler EM, Hanrahan JP, et al. Spirochetes isolated from the blood of two patients with Lyme disease. N Engl J Med. 1983;308(13):740–2. https://doi.org/10.1056/NEJM198303313081302.
Ackermann R, Kabatzki J, Boisten HP, et al. Spirochäten-Ätiologie der Erythema-chronicum-migrans-Krankheit. Dtsch Med Wochenschr. 1984;109(3):92–7. https://doi.org/10.1055/s-2008-1069145. [Spirochete etiology of erythema chronicum migrans disease].
Pfister HW, Einhäupl KM, Preac-Mursic V, et al. The spirochetal etiology of lymphocytic meningoradiculitis of Bannwarth (Bannwarth’s syndrome). J Neurol. 1984;231(3):141–4. https://doi.org/10.1007/BF00313682.
Asbrink E, Hovmark A. Successful cultivation of spirochetes from skin lesions of patients with erythema chronicum migrans Afzelius and acrodermatitis chronica atrophicans. Acta Pathol Microbiol Immunol Scand B. 1985;93(2):161–3. https://doi.org/10.1111/j.1699-0463.1985.tb02870.x.
Hovmark A, Asbrink E, Olsson I. The spirochetal etiology of lymphadenosis benigna cutis solitaria. Acta Derm Venereol. 1986;66(6):479–84.
Weber K, Schierz G, Wilske B, et al. Das Lymphozytom – eine Borrelize? Z Hautkr. 1985;60(20):1585–98. [Lymphocytoma—a borreliosis?].
Asbrink E, Hovmark A, Olsson I. Lymphadenosis benigna cutis solitaria – borrelia lymphocytoma in Sweden. Zentralbl Bakteriol. 1989;18(Suppl):156–63.
Asbrink E, Hovmark A. Early and late cutaneous manifestations in Ixodes-borne borreliosis (erythema migrans borreliosis, Lyme borreliosis). Ann NY Acad Sci. 1988;539:4–15. https://doi.org/10.1111/j.1749-6632.1988.tb31833.x.
Asbrink E, Hovmark A. Comments on the course and classification of Lyme borreliosis. Scand J Infect Dis Suppl. 1991;77:41–3.
Weber K, Neubert U. Clinical features of early erythema migrans disease and related disorders. Zentralbl Bakteriol Mikrobiol Hyg A. 1986;263(1–2):209–28. https://doi.org/10.1016/s0176-6724(86)80125-0.
Asbrink E. Cutaneous manifestations of Lyme borreliosis. Clinical definitions and differential diagnose. Scand J Infect Dis Suppl. 1991;77:44–50.
Stanek G, Fingerle V, Hunfeld KP, et al. Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect. 2011;17(1):69–79. https://doi.org/10.1111/j.1469-0691.2010.03175.x.
Pohl-Koppe A, Wilske B, Weiss M, et al. Borrelia lymphocytoma in childhood. Pediatr Infect Dis J. 1998;17(5):423–6. https://doi.org/10.1097/00006454-199805000-00017.
Vuković K, Žnidaršič M, Arnež M. Borelijski limfocitom pri otrocih v Sloveniji—demografske, klinične in laboratorijske značilnosti. Med Razgl. 2010;49:237–46. [Borrelial lymphocytoma in children in Slovenia—demographic, clinical, and laboratory characteristics].
Arnež M, Ružić-Sabljić E. Borrelial lymphocytoma in children. Pediatr Infect Dis J. 2015;34(12):1319–22. https://doi.org/10.1097/INF.0000000000000884.
Hauser W. Wahrscheinliche Infektionkrankheiten der Haut. In: Marchionini A, Götz H, editors. Infektionkrankheiten der Haut I. Berlin, Heildelberg, New York: Springer; 1965. pp. 556–629.
Hovmark A, Asbrink E, Weber K, et al. Borrelial lymphocytoma. In: Weber K, Burgdorfer W, editors. Aspects of Lyme borreliosis. Berlin, Heidelberg: Springer; 1993. pp. 122–30.
Strle F, Pleterski-Rigler D, Stanek G, et al. Solitary borrelial lymphocytoma: report of 36 cases. Infection. 1992;20(4):201–6. https://doi.org/10.1007/BF02033059.
Strle F, Maraspin V, Pleterski-Rigler D, et al. Treatment of borrelial lymphocytoma. Infection. 1996;24(1):80–4. https://doi.org/10.1007/BF01780665.
Maraspin V, Cimperman J, Lotrič-Furlan S, et al. Solitary borrelial lymphocytoma in adult patients. Wien Klin Wochenschr. 2002;114(13–14):515–23.
Maraspin V, Nahtigal Klevišar M, Ružić-Sabljić E, et al. Borrelial lymphocytoma in adult patients. Clin Infect Dis. 2016;63(7):914–21. https://doi.org/10.1093/cid/ciw417.
De Koning J, Duray PH. Histopathology of human Lyme borreliosis. In: Weber K, Burgdorfer W, editors. Aspects of Lyme borreliosis. Berlin, Heidelberg: Springer; 1993. pp. 70–92.
Colli C, Leinweber B, Müllegger R, et al. Borrelia burgdorferi—associated lymphocytoma cutis: clinicopathologic, immunophenotypic, and molecular study of 106 cases. J Cutan Pathol. 2004;31(3):232–40. https://doi.org/10.1111/j.0303-6987.2003.00167.x.
Müllegger RR, Glatz M. Skin manifestations of lyme borreliosis: diagnosis and management. Am J Clin Dermatol. 2008;9(6):355–68. https://doi.org/10.2165/0128071-200809060-00002.
Müllegger RR, Means TK, Shin JJ, et al. Chemokine signatures in the skin disorders of Lyme borreliosis in Europe: predominance of CXCL9 and CXCL10 in erythema migrans and acrodermatitis and CXCL13 in lymphocytoma. Infect Immun. 2007;75(9):4621–8. https://doi.org/10.1128/IAI.00263-07.
Finkel MF, Johnson RC. Borrelia lymphocytoma: a possible North American case. Wis Med J. 1990;89(12):683–6.
Albrecht S, Hofstadter S, Artsob H, et al. Lymphadenosis benigna cutis resulting from Borrelia infection (Borrelia lymphocytoma). J Am Acad Dermatol. 1991;24(4):621–5. https://doi.org/10.1016/0190-9622(91)70095-j.
Srinivasalu H, Brescia AC, Rose CD. Lyme chondritis presenting as painless ear erythema. Pediatrics. 2013;131(6):e1977–e81. https://doi.org/10.1542/peds.2012-1225.
Remiker A, Haslam D, Kalfa TA. A painless erythematous swelling of the external ear as a manifestation of Lyme disease: a case report. J Med Case Rep. 2020;14(1):48. https://doi.org/10.1186/s13256-020-02377-x.
Gordillo-Pérez G, Torres J, Solórzano-Santos F, et al. Borrelia burgdorferi infection and cutaneous Lyme disease, Mexico. Emerg Infect Dis. 2007;13(10):1556–8. https://doi.org/10.3201/eid1310.060630.
Colunga-Salas P, Sánchez-Montes S, Volkow P, et al. Lyme disease and relapsing fever in Mexico: An overview of human and wildlife infections. PLoS One. 2020;15(9):e238496. https://doi.org/10.1371/journal.pone.0238496.
Stanek G, Flamm H, Groh V, et al. Epidemiology of borrelia infections in Austria. Zentralbl Bakteriol Mikrobiol Hyg A. 1987;263(3):442–9. https://doi.org/10.1016/s0176-6724(87)80106-2.
Stanek G, Pletschette M, Flamm H, et al. European Lyme borreliosis. Ann NY Acad Sci. 1988;539:274–82. https://doi.org/10.1111/j.1749-6632.1988.tb31861.x.
Berglund J, Eitrem R, Ornstein K, et al. An epidemiologic study of Lyme disease in southern Sweden. N Engl J Med. 1995;333(20):1319–27. https://doi.org/10.1056/NEJM199511163332004.
Lipsker D, Hansmann Y, Limbach F, et al. Disease expression of Lyme borreliosis in northeastern France. Eur J Clin Microbiol Infect Dis. 2001;20(4):225–30. https://doi.org/10.1007/s100960100476.
Strle F. Lyme borreliosis in Slovenia. Zentralbl Bakteriol. 1999;289(5–7):643–52. https://doi.org/10.1016/s0934-8840(99)80023-1.
Picken RN, Strle F, Ružić-Sabljić E, et al. Molecular subtyping of Borrelia burgdorferi sensu lato isolates from five patients with solitary lymphocytoma. J Invest Dermatol. 1997;108(1):92–7. https://doi.org/10.1111/1523-1747.ep12285646.
Ružić-Sabljić E, Strle F, Cimperman J, et al. Characterisation of Borrelia burgdorferi sensu lato strains isolated from patients with skin manifestations of Lyme borreliosis residing in Slovenia. J Med Microbiol. 2000;49(1):47–53. https://doi.org/10.1099/0022-1317-49-1-47.
Ružić-Sabljić E, Maraspin V, Lotrič-Furlan S, et al. Characterization of Borrelia burgdorferi sensu lato strains isolated from human material in Slovenia. Wien Klin Wochenschr. 2002;114(13–14):544–50.
Ghislain PD, Woestyn S, Tennstedt D, et al. Borrelia afzelii evidenced by polymerase chain reaction in a biopsy of nipple lymphocytoma. Br J Dermatol. 2003;148(2):377–9. https://doi.org/10.1046/j.1365-2133.2003.05097_12.x.
Lenormand C, Jaulhac B, De Martino S, et al. Species of Borrelia burgdorferi complex that cause borrelial lymphocytoma in France. Br J Dermatol. 2009;161(1):174–6. https://doi.org/10.1111/j.1365-2133.2009.09100.x.
Busch U, Hizo-Teufel C, Böhmer R, et al. Borrelia burgdorferi sensu lato strains isolated from cutaneous Lyme borreliosis biopsies differentiated by pulsed-field gel electrophoresis. Scand J Infect Dis. 1996;28(6):583–9. https://doi.org/10.3109/00365549609037965.
Maraspin V, Ogrinc K, Ružić-Sabljić E, Lotrič-Furlan S, Strle F, et al. Isolation of Borrelia burgdorferi sensu lato from blood of adult patients with borrelial lymphocytoma, Lyme neuroborreliosis, Lyme arthritis, and acrodermatitis chronica atrophicans. Infection. 2011;39(1):35–40. https://doi.org/10.1007/s15010-010-0062-8.
Cerar T, Strle F, Stupica D, et al. Differences in genotype, clinical features, and inflammatory potential of Borrelia burgdorferi sensu stricto strains from Europe and the United States. Emerg Infect Dis. 2016;22(5):818–27. https://doi.org/10.3201/eid2205.151806.
Gautier C, Vignolly B, Taïeb A. Benign cutaneous lymphocytoma of the breast areola and erythema chronicum migrans: a pathognomonic association of Lyme disease. Arch Pediatr. 1995;2(4):343–6. https://doi.org/10.1016/0929-693x(96)81157-2.
Steiner A, Stehr K, Rösch W. Lymphocytoma cutis benigna. Case report of a 9 year old boy. Urologe A. 2007;46(2):160–2. https://doi.org/10.1007/s00120-006-1284-3.
Sewnaik A, Kamarashev J, Peters NS, et al. A non-traumatic, blue-purple auricle: case report. J Laryngol Otol. 2010;124(7):804–6. https://doi.org/10.1017/S0022215109992210.
Palmen C, Jamblin P, Florkin B, et al. Borrelia-associated lymphocytoma cutis. Arch Pediatr. 2010;17(8):1159–61. https://doi.org/10.1016/j.arcped.2010.05.004.
Belloni B, Andres C, Ring J, et al. 5‑yr-old with borrelial lymphocytoma. MMW Fortschr Med. 2011;153(10):40.
Moniuszko A, Czupryna P, Pancewicz S, et al. Borrelial lymphocytoma—a case report of a pregnant woman. Ticks Tick Borne Dis. 2012;3(4):257–8. https://doi.org/10.1016/j.ttbdis.2012.06.004.
Colucci R, Galeone M, Arunachalam M, et al. Red nodule on the breast. Indian J Dermatol. 2012;57(5):387–9. https://doi.org/10.4103/0019-5154.100496.
Foessel L, Bretz-Grenier MF, Weingertner N, et al. Borrelial lymphocytoma of the breast areola in a 52-year old man: an uncommon manifestation of Lyme disease. Diagn Interv Imaging. 2013;94(1):104–7. https://doi.org/10.1016/j.diii.2012.09.009.
Kroon MW, Roest RW. A man with a swollen nipple. Ned Tijdschr Geneeskd. 2013;157(43):A6067.
Schatorjé EJ, van der Steeg H, Stelma F, et al. Borrelial lymphocytoma. Ned Tijdschr Geneeskd. 2013;157(52):A6605.
Kandhari R, Kandhari S, Jain S. Borrelial lymphocytoma cutis: a diagnostic dilemma. Indian J Dermatol. 2014;59(6):595–7. https://doi.org/10.4103/0019-5154.143530.
Llamas-Velasco M, Paredes BE. Borrelia lymphocytoma mimicking butterfly rash in a pediatric patient. Am J Dermatopathol. 2018;40(3):216–8. https://doi.org/10.1097/DAD.0000000000001013.
Nielsen RM, Bygum A. A child with a swollen nipple: a quiz. Acta Derm Venereol. 2019;99(11):1065–6. https://doi.org/10.2340/00015555-3266.
Yildiz H, Marot L. Borrelial lymphocytoma of the lip. Lancet Infect Dis. 2019;19(11):1264. https://doi.org/10.1016/S1473-3099(19)30287-7.
Kluger N, Keinonen A, Jeskanen L, et al. Lyme borreliosis mimicking auricular chondritis. Ann Dermatol Venereol. 2019;146(8–9):596–9. https://doi.org/10.1016/j.annder.2019.03.003.
Obihara CC, de Geer DB, van Diemen-Steenvoorde JA, et al. Borrelia lymphocytoma (“winter ears”) in children. Ned Tijdschr Geneeskd. 1997;141(10):482–4.
Buettcher M. Borrelial lymphocytoma presentations of the ear. Arch Dis Child. 2022;107(5):490. https://doi.org/10.1136/archdischild-2021-322652.
Ventéjou S, Bourban-Jirounek C, Christen-Zaech S, et al. An atypical presentation of borrelial lymphocytoma in 4 children. Ann Dermatol Venereol. 2022;149(1):61–3. https://doi.org/10.1016/j.annder.2021.06.004.
Glatz M, Resinger A, Semmelweis K, et al. Clinical spectrum of skin manifestations of Lyme borreliosis in 204 children in Austria. Acta Derm Venereol. 2015;95(5):565–71. https://doi.org/10.2340/00015555-2000.
Strle F, Wormser GP, Mead P, et al. Gender disparity between cutaneous and non-cutaneous manifestations of Lyme borreliosis. PLoS One. 2013;8(5):e64110. https://doi.org/10.1371/journal.pone.0064110.
Ogrinc K, Maraspin V, Lusa L, et al. Acrodermatitis chronica atrophicans: clinical and microbiological characteristics of a cohort of 693 Slovenian patients. J Intern Med. 2021;290(2):335–48. https://doi.org/10.1111/joim.13266.
Asbrink E, Hovmark A. Cutaneous manifestations in Ixodes-borne Borrelia spirechetosis. Int J Dermatol. 1987;26(4):215–23. https://doi.org/10.1111/j.1365-362.1987.tb00902.x.
Strle F, Stanek G. Clinical manifestations and diagnosis of Lyme borreliosis. Curr Probl Dermatol. 2009;37:51–110. https://doi.org/10.1159/000213070.
Paschoud JM. Lymphocytom nach Zeckenbiss. Dermatologica. 1954;108(4–6):435–7. [Lymphocytoma after a tick bite].
Gottron H. Lymphadenosis cutis circumscripta im Bereich der mamille bei gleichzeitinger Acrodematitis chron. Atrophicans der Extemitäten. Zentralbl Hautkr. 1938;59:633.
Strle F, Lusa L, Ružić-Sabljić E, et al. Clinical characteristics associated with Borrelia burgdorferi sensu lato skin culture results in patients with erythema migrans. PLoS ONE. 2013;8(12):e82132. https://doi.org/10.1371/journal.pone.0082132.
Boršič K, Blagus R, Cerar T, et al. Clinical course, serologic response, and long-term outcome in elderly patients with early Lyme borreliosis. J Clin Med. 2018;7(12):506. https://doi.org/10.3390/jcm7120506.
Grange F, Wechsler J, Guillaume JC, et al. Borrelia burgdorferi-associated lymphocytoma cutis simulating a primary cutaneous large B‑cell lymphoma. J Am Acad Dermatol. 2002;47(4):530–4. https://doi.org/10.1067/mjd.2002.120475.
Müllegger RR. Dermatological manifestations of Lyme borreliosis. Eur J Dermatol. 2004;14(5):296–309.
Weber K, Neubert U, Thurmayr R. Antibiotic therapy in early erythema migrans disease and related disorders. Zentralbl Bakteriol Mikrobiol Hyg A. 1987;263(3):377–88. https://doi.org/10.1016/s0176-6724(87)80096-2.
Weber K, Preac-Mursic V, Neubert U, et al. Antibiotic therapy of early European Lyme borreliosis and acrodermatitis chronica atrophicans. Ann N Y Acad Sci. 1988;539:324–45. https://doi.org/10.1111/j.1749-6632.1988.tb31867.x.
Weber K, Thurmayr R. Oral penicillin versus minocycline for the treatment of early Lyme borreliosis. Zentralbl Bakteriol Mikrobiol Hyg A. 1989;18:263–8.
Weber K. Therapy of cutaneous manifestations. In: Weber K, Burgdorfer W, Schierz G, editors. Aspects of Lyme borreliosis. Berlin, Heidelberg: Springer; 1993. pp. 312–27.
Strle F. Principles of the diagnosis and antibiotic treatment of Lyme borreliosis. Wien Klin Wochenschr. 1999;111(22–23):911–5.
Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089–134. https://doi.org/10.1086/508667.
Arnež M. Antibiotic treatment of children with erythema migrans. Clin Infect Dis. 2007;44(8):1133–4. https://doi.org/10.1086/512978. author reply 1137–1139.
Stanek G, Wormser GP, Gray J, et al. Lyme borreliosis. Lancet. 2012;379(9814):461–73. https://doi.org/10.1016/S0140-6736(11)60103-7.
Stanek G, Strle F. Lyme borreliosis—from tick bite to diagnosis and treatment. FEMS Microbiol Rev. 2018;42(3):233–58. https://doi.org/10.1093/femsre/fux047.
Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis, and treatment of Lyme disease. Clin Infect Dis. 2021;72(1):e1–e48. https://doi.org/10.1093/cid/ciaa1215.
Strle F, Wormser GP. Erythema migrans and its mimics. Infect Dis Clin North Am. 2022. In press.
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This work was supported by the Slovenian Research Agency (P3-0296, J3-1744) to F.S. The funding agency was not involved in the design, conduct, or interpretation of the findings.
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F. Strle served on the scientific advisory board for Roche on Lyme disease serologic diagnostics and on the scientific advisory board for Pfizer, Inc., on Lyme disease vaccine and is an unpaid member of the steering committee of the ESCMID Study Group on Lyme Borreliosis/ESGBOR. V. Maraspin declare that she has no competing interests.
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Maraspin, V., Strle, F. Borrelial lymphocytoma. Wien Klin Wochenschr 135, 190–202 (2023). https://doi.org/10.1007/s00508-022-02064-5
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DOI: https://doi.org/10.1007/s00508-022-02064-5