Eosinophilic folliculitis occurring after stem cell transplant for acute lymphoblastic leukemia: a case report and review

Abstract

A fourth proposed subtype of EF is associated with HIV-negative hematologic disease. This subtype is distinguished by a predictable timeframe to presentation and a relatively rapid response to therapy. Although EF is an important consideration in all patients with hematologic malignancy, clinically heightened suspicion is warranted during the 2-3 months after transplant.

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

“…Importantly, histologic findings are variable and may depend on the stage of disease at the time of biopsy. Peri-infundibular lymphocytic infiltrates with variable numbers of eosinophils are seen early while infundibular spongiosis, vesiculation, and pustule formation with infiltration of folliculosebaceous units by eosinophils is seen when lesions are more well established 1 . Treatments with variable reported efficacies include indomethacin, topical and systemic steroids, phototherapy, isotretinoin, and, if HIV associated, highly active antiretroviral therapy.…”

“…Treatments with variable reported efficacies include indomethacin, topical and systemic steroids, phototherapy, isotretinoin, and, if HIV associated, highly active antiretroviral therapy. In patients with underlying hematologic malignancy, resolution with minimal specific treatment is typical, occurring after 8 weeks 1, 7…”

“…Additionally, the occurrence of EF after chemotherapy, bone marrow transplantation (BMT), or stem cell transplantation (SCT) is a commonly reported feature 1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15Table IIClinicopathologic features of EF associated with underlying hematologic malignancy other than CLLStudyAge, ySexUnderlying hematologic malignancyTreatment for malignancyPeripheral eosinophiliaClinical descriptionDistributionNotable histologic featuresTakamura et al 6 77MMantle cell lymphomaChemotherapy13%Pruritic, erythematous papulesFace, neckEosinophils around follicles and sebaceous glandsTakamura et al 6 60MMantle cell lymphomaChemotherapy3.7%Pruritic, follicular reddish papulesFaceEosinophils around follicles and sebaceous glandsBhandare et al 8 64FSplenic marginal zone lymphomaChemotherapy2968/mL 3 Pruritic, follicular papules and pustulesScalp, back, proximal extremitiesFollicular spongiosis with eosinophilsZitelli et al 1 56MAcute lymphoblastic leukemiaAutologous SCT6.4%Pruritic papules and pustulesFace, chest, and backIntrafollicular collections of eosinophilsSugaya et al 9 42MSézary syndromeN/A9.5%Pruritic reddish follicular papulesCheeksProminent follicular exocytosis of eosinophilsRashid et al 10 74MChronic myelomonocytic leukemiaChemotherapyN/APruritic perifollicular papulesNeck and chestPerifollicular infiltrates with eosinophils, follicular mucinGoiriz et al 7 25FAcute eosinophilic leukemiaAllogene...…”

“…A fourth less commonly recognized subtype of EF is that associated with hematologic malignancy, in particular leukemia and non-Hodgkin lymphoma (NHL) 1 . EF in HIV-negative individuals and associated with hematologic malignancy was first reported in 1993 2 .…”

Eosinophilic pustular folliculitis associated with hematological disorders: A report of two cases and review of Japanese literature

“…The skin lesion of IS‐associated EPF is different from that of classic EPF and shows discrete urticarial follicular papules; in addition, pruritus tends to be more severe than that of the classic EPF. IS‐associated EPF has been reported to occur not only in patients with HIV infection, but also in those with hematological disorders (HD), such as leukemia and lymphoma . The HD‐associated EPF may be observed both in patients who underwent bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) (transplantation‐related EPF, T‐EPF) and in those with hematological malignancy (HM) who do not undergo hematological transplantation (HM‐related EPF; HM‐EPF); however, detailed clinical information about HD‐associated EPF is scarce.…”