Eosinophilic dermatosis of hematologic malignancy

Abstract

Cutaneous involvement by an eosinophil-rich process (eosinophilic dermatosis) may be encountered in the setting of various hematologic malignancies, including mantle cell lymphoma, acute monocytic leukemia, acute lymphoblastic leukemia, large cell lymphoma, myelofibrosis and chronic lymphocytic leukemia (CLL). Of the various hematologic malignancies, eosinophilic dermatosis has been most frequently described in association with CLL. Published previously as insect bite-like reaction and eosinophilic dermatosis of myeloproliferative disease, this rare dermatitis presents as a pruritic, papular and occasionally vesicular eruption associated with an eosinophil-rich infiltrate histopathologically. Although clinical and histopathologic features are similar to insect bites, affected patients frequently deny a history of insect bites. We report a case of eosinophilic dermatosis of hematologic malignancy in a patient with known history of CLL.

Eosinophilic folliculitis in association with chronic lymphocytic leukemia: A clinicopathologic series

“…Of note, a condition termed eosinophilic dermatosis of hematologic malignancy has also been described in the literature, with striking clinicopathologic overlap with the cases described in this series in terms of morphology, distribution, context of underlying lymphoproliferative disorder (including CLL), perifollicular and intrafollicular eosinophilia, and natural history 16 . Thus, it is likely that eosinophilic dermatosis of hematologic malignancy represents the same entity described herein—EF.…”

Lenalidomide in the management of eosinophilic dermatosis of hematological malignancy

“…It is believed that in a patient with immunodeficiency due to hematological disease a trigger like insect bite, drug or virus induces cytokine production with an excess of interleukin‐4 and ‐5 and an altered immune response with predominance of eosinophils . The eruption occurs concurrent with or months to years after the onset of the hematological malignancy, but occasionally can precede the diagnosis . In our case, the diagnosis of mantle cell lymphoma and EDHM was made at the same time, but in the clinical history of the patient the pruritic eruption was present 2 years prior to the developing of palpable lymph nodes and B symptoms.…”

“…They may be detected in other eosinophilic dermatoses associated with cutaneous eosinophilia such as eosinophilic cellulitis, bullous pemphigoid, eczema, prurigo, herpes gestationis, drug eruption and scabies . The lymphoid infiltrate is composed of either mixed T and B cells or largely of T cells that are CD3, CD43 and CD45RO positive with occasional presence of nodular lymphoid aggregates recapitulating germinal centers . No leukemic cells are observed.…”

Exaggerated arthropod assault: Eosinophilic dermatosis in a patient with small lymphocytic lymphoma

“…In the case of CLL, the pathophysiology is yet to be fully understood; however, it is thought to occur as the result of a type IV delayed hypersensitivity reaction, as the cutaneous lesions are rich in T cells in addition to eosinophils, leading to the hypothesis that such a reaction represents an exaggerated response to arthropod bites 2, 4, 5, 6, 8. This was illustrated in a case of 8 patients with CLL who developed significant dermal reactions from exposure to mosquito antigen versus control patients 9.…”