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

Abstract

Eosinophilic pustular folliculitis (EPF) occurs in patients with hematological disorders. However, clinical information about hematological disorder-associated EPF is scarce. We report two cases of EPF associated with mantle cell lymphoma and reviewed the available published work on Japanese cases. We identified a total of 23 Japanese cases, including the two cases reported here, who had hematological disorder-associated EPF. Fourteen cases were associated with treatment for hematological malignancies (transplantation-related EPF) and nine cases were associated with hematological malignancies themselves (hematological malignancy-related EPF). Although the skin eruption was clinically indistinguishable between the two subtypes, transplantation-related EPF occurred on the face and trunk of young and middle-aged men and women, whereas hematological malignancy-related EPF occurred mostly on the face of older men. Peripheral blood eosinophilia was more frequently observed in transplantation-related EPF. These observations suggest variations among patients with EPF associated with hematological disorders.

Eosinophilic folliculitis in a patient with chronic myelomonocytic leukemia

“…EF has also been described following chemotherapy, bone marrow transplantation, and peripheral blood stem cell transplantation. In the context of hematologic malignancy, EF presents with follicular papules and vesicles above the waist 7 . EF is markedly pruritic in all forms.…”

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

“…Paradoxically, pustules are usually absent in the HIV-associated subtype. All forms of EF are associated with marked pruritus and may demonstrate an associated peripheral eosinophilia 6 . Importantly, histologic findings are variable and may depend on the stage of disease at the time of biopsy.…”

“…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...…”

Immune-Mediated Dermatoses in Patients with Haematological Malignancies: A Comprehensive Review

“…In Asian countries, a distinct presentation of EDHM includes "eosinophilic pustular folliculitis of HM". It features pruritic, reddish, sterile, follicular papules and pustules; microscopic examination shows an inflammatory infiltrate consisting of lymphocytes and eosinophils around the hair follicles and sebaceous glands, similar to Ofuji disease [115,116]. Another presentation of EDHM resembling varicella zoster infection has also been reported [117].…”