'Exaggerated Reactions' to Insect Bites Can Linger in CLL Patients

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Int J Clin Pract. 2004 Dec;58(12):1177-9.

An itchy vesiculobullous eruption in a patient with chronic

lymphocytic leukaemia.

Cocuroccia B, Gisondi P, Gubinelli E, Girolomoni G.

Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy.

Exaggerated reactions to insect bites are characteristic of patients

with haemoproliferative disorders, particularly chronic lymphocytic

leukaemia (CLL).

Skin lesions usually appear after the diagnosis of leukaemia and seem

unrelated to laboratory findings, disease course or therapy. Rarely,

the eruption may precede the diagnosis of the haematologic

malignancy.

The patients usually do not recall of insect bites, and the diagnosis

may require histological and laboratory investigations to exclude

specific lesions or autoimmune bullous diseases.

Lesions may run a chronic course and represent a therapeutic

challenge.

Here, we report an adult patient with CLL who developed itchy

recurrent papulovesicular and bullous lesions. Differential diagnosis

was made with cutaneous specific lesions of CLL, bullous pemphigoid

and pemphigus vulgaris, but laboratory and histological

investigations confirmed the diagnosis of an insect bite reaction.

The patient was treated with oral H1 anti-histamines and topical

corticosteroids under occlusion, with marked improvement after 10

days.

PMID: 15646420 [PubMed - in process]