Exaggerated arthropod-bite lesions in patients with chronic lymphocytic leukemia: a clinical, histopathologic, and immunopathologic study of eight patients.
BACKGROUND
Unusual papulovesicular lesions resembling arthropod bites have been described in patients with chronic lymphocytic leukemia (CLL).


OBJECTIVE
Our purpose was to describe and characterize further the clinical, histopathologic, and immunopathologic features of these lesions.


METHODS
Eight patients were identified retrospectively who had CLL and characteristic skin lesions. Clinical and histologic features were recorded. Skin biopsy specimens were analyzed immunohistochemically for eosinophil granule major basic protein, eosinophil-derived neurotoxin, neutrophil elastase, and mast cell tryptase.


RESULTS
The clinical features, including the lesional distribution, suggested arthropod bites, although most patients could not recall having been bitten. Mixed T- and B-cell lymphoid cell infiltrates were present within lesions, along with prominent eosinophil infiltration and eosinophil granule protein deposition.


CONCLUSIONS
Exuberant papulovesicular lesions develop in patients with CLL apparently as an exaggerated response to arthropod bites. Prominent eosinophil infiltration and degranulation within these lesions likely contribute to the severity of symptoms.
Davis
M D
MD
Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Perniciaro
C
C
Dahl
P R
PR
Randle
H W
HW
McEvoy
M T
MT
Leiferman
K M
KM
D000368:Aged; D000818:Animals; D001181:Arthropods; D001402:B-Lymphocytes / Q000473:pathology; D001706:Biopsy; D001798:Blood Proteins / Q000032:analysis; D015550:Cell Degranulation; D053818:Chymases; D047091:Eosinophil Granule Proteins; D047208:Eosinophil-Derived Neurotoxin; D004804:Eosinophils / Q000201:enzymology / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D018836:Inflammation Mediators / Q000032:analysis; D007299:Insect Bites and Stings / Q000276:immunology / Q000473:pathology*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology / Q000473:pathology*; D019272:Leukocyte Elastase / Q000032:analysis; D008297:Male; D008407:Mast Cells / Q000201:enzymology / Q000473:pathology; D008875:Middle Aged; D009504:Neutrophils / Q000201:enzymology / Q000473:pathology; D011506:Proteins / Q000032:analysis; D012189:Retrospective Studies; D012259:Ribonuclease, Pancreatic / Q000032:analysis; D012260:Ribonucleases; D012697:Serine Endopeptidases / Q000032:analysis; D012867:Skin / Q000276:immunology / Q000473:pathology*; D012872:Skin Diseases, Vesiculobullous / Q000276:immunology / Q000473:pathology; D013601:T-Lymphocytes / Q000473:pathology; D053802:Tryptases
D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D018836:Inflammation Mediators; D011506:Proteins; D047208:Eosinophil-Derived Neurotoxin; D012260:Ribonucleases; D012259:Ribonuclease, Pancreatic; D012697:Serine Endopeptidases; C083294:chymase 2; D019272:Leukocyte Elastase; D053818:Chymases; D053802:Tryptases