title: Insect bite-like reaction in patients with hematologic malignant neoplasms.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel. aviv@post.tau.ac.il
authors.forename: A
authors.initials: A
authors.lastname: Barzilai
authors.forename: D
authors.initials: D
authors.lastname: Shpiro
authors.forename: I
authors.initials: I
authors.lastname: Goldberg
authors.forename: Y
authors.initials: Y
authors.lastname: Yacob-Hirsch
authors.forename: C
authors.initials: C
authors.lastname: Diaz-Cascajo
authors.forename: D
authors.initials: D
authors.lastname: Meytes
authors.forename: R
authors.initials: R
authors.lastname: Schiby
authors.forename: N
authors.initials: N
authors.lastname: Amariglio
authors.forename: H
authors.initials: H
authors.lastname: Trau
mesh_terms: D000293:Adolescent; D000368:Aged; D003937:Diagnosis, Differential; D005076:Exanthema / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007299:Insect Bites and Stings / Q000175:diagnosis* / Q000473:pathology; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000473:pathology; D007948:Leukemia, Monocytic, Acute / Q000175:diagnosis / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000473:pathology; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000473:pathology; D012008:Recurrence; D012867:Skin / Q000473:pathology