Exaggerated arthropod-bite lesions in patients with chronic lymphocytic leukemia: A clinical, histopathologic, and immunopathologic study of eight patients

Davis, Mark D.P.; Perniciaro, Charles; Dahl, Patrick R.; Randle, Henry W.; McEvoy, Marian T.; Leiferman, Kristin M.

doi:10.1016/s0190-9622(98)70398-6

Cited by 105 publications

(176 citation statements)

References 35 publications

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“…2,18,23,24 Certain patient populations, such as those with hematologic abnormalities, have a greater tendency to develop exaggerated responses after arthropod bites. For instance, it has been well described that patients with chronic lymphocytic leukemia tend to develop exaggerated responses to arthropod bites, which manifest as vesicles or bullae with prominent edema and erythema that may be accompanied by lymphadenopathy and lymphangitic streaking [25][26][27] (Figure 2). Patients with lymphangitic streaking associated with an uncomplicated arthropod bite can be successfully managed with antihistamines and/or topical or oral steroids.…”

Section: Arthropod Bitesmentioning

confidence: 99%

Nonbacterial Causes of Lymphangitis with Streaking

Cohen

Nagler

Pomeranz³

2016

The Journal of the American Board of Family Medicine

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Background: Lymphangitic streaking, characterized by linear erythema on the skin, is most commonly observed in the setting of bacterial infection. However, a number of nonbacterial causes can result in lymphangitic streaking. We sought to elucidate the nonbacterial causes of lymphangitic streaking that may mimic bacterial infection to broaden clinicians' differential diagnosis for patients presenting with lymphangitic streaking.Methods: We performed a review of the literature, including all available reports pertaining to nonbacterial causes of lymphangitic streaking.Results: Various nonbacterial causes can result in lymphangitic streaking, including viral and fungal infections, insect or spider bites, and iatrogenic etiologies.

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Section: Arthropod Bitesmentioning

confidence: 99%

Nonbacterial Causes of Lymphangitis with Streaking

Cohen

Nagler

Pomeranz³

2016

The Journal of the American Board of Family Medicine

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“…[3][4][5][6][7] One case is also reported in a patient with lymphocytic lymphoma. 9 In all cases but 1, 7 skin lesions appeared months to years after the diagnosis of leukemia or lymphoma and were unrelated to laboratory findings, disease course, or therapy given.…”

Section: Commentmentioning

confidence: 99%

“…22 The insect bite-like reaction in these patients seems to pose a therapeutic challenge. Davis et al 7 reported variable improvement in some of their patients who underwent chemotherapy for the CLL. Oral glucocorticoids and intravenous immunoglobulin seemed to work better, while antibiotics were not helpful at all.…”

Section: Patient Characteristics and Clinical Data On The Insect Bitementioning

confidence: 99%

“…1,2 Among lesions in the latter group, exaggerated reaction to insect bite is infrequently described in patients with chronic lymphocytic leukemia (CLL). [3][4][5][6][7] We describe 8 patients with various hematologic diseases in whom insect bite-like reaction occurred and discuss this phenomenon. Table. In all patients, the clinical appearance was that of red itchy papules or plaques (Figure 1).…”

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confidence: 99%

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Insect Bite–like Reaction in Patients With Hematologic Malignant Neoplasms

Barzilai¹,

Shpiro²,

Goldberg³

et al. 1999

Arch Dermatol

115

195

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Background: Exaggerated reaction to insect bites, mainly to mosquitoes, is infrequently described in patients with chronic lymphocytic leukemia. Skin lesions usually appear months to years after the diagnosis of leukemia and are unrelated to laboratory findings, disease course, or therapy.Observations: We describe 8 patients with various hematologic disorders (chronic lymphocytic leukemia, acute lymphoblastic leukemia, acute monocytic leukemia, mantle-cell lymphoma, large-cell lymphoma, and myelofibrosis) who developed insect bite-like reaction. Although the clinical picture and the histological characteristics of the lesions were typical for insect bites, none of the patients actually had a history, course, or response to treatment suggestive of arthropod assaults. In 2 patients, the eruption preceded the diagnosis of the ma-lignant neoplasm. The rash persisted for months to years and was resistant to therapies other than systemic corticosteroids. The 3 patients with chronic lymphocytic leukemia seemed to have a worse prognosis than expected for their disease. In 1, the polymerase chain reaction detected leukemic cells in the infiltrate.Conclusions: Insect bite-like reaction is an infrequent, disturbing, and difficult-to-treat nonspecific phenomenon in patients with hematologic malignant neoplasms. Since it may precede the hematologic disorder, oriented evaluation is warranted. We speculate that immunodeficiency plays a role in its pathogenesis; however, the exact pathogenesis and its prognostic implications await further studies.

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“…Given the lack of initial response, he underwent repeat skin biopsy showing nodular mixed dermatitis and lobular panniculitis with numerous eosinophils and “flame figures” (eosinophilic degranulation) (Figure 1). 1 No leukemic or neutrophilic infiltrate was appreciated. In this clinical context, the changes were most suggestive of an exuberant or persistent response to an arthropod bite.…”

Section: Case Presentationmentioning

confidence: 99%