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Insect Bite–like Reaction in Patients With Hematologic Malignant Neoplasms
Aviv Barzilai, MD, MSc;
Dorit Shpiro, MD;
Iris Goldberg, PhD;
Yasmin Yacob-Hirsch, MSc;
Carlos Diaz-Cascajo, MD;
Dina Meytes, MD;
Regina Schiby, MD;
Ninette Amariglio, PhD;
Henri Trau, MD
Arch Dermatol. 1999;135:1503-1507.
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 malignant 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.
From the Department of Dermatology (Drs Barzilai, Shpiro, and Trau) and the Institutes of Pathology (Drs Goldberg and Schiby) and Hematology (Ms Yacob-Hirsch and Dr Amariglio), Sheba Medical Center, Tel-Hashomer, Israel; the Institutes of Pathology (Dr Barzilai) and Hematology (Dr Meytes), Wolfson Medical Center, Holon, Israel; the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Barzilai, Shpiro, Goldberg, Meytes, Schiby, Amariglio, and Trau and Ms Yacob-Hirsch); and the Center for Dermatopathology, Freiburg, Germany (Dr Diaz-Cascajo).
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