title: Insect-bite-like reaction in patients with chronic lymphocytic leukemia: a study from the Israeli Chronic Lymphocytic Leukemia Study Group.
abstract: An insect-bite-like reaction is known to occur in patients with chronic lymphocytic leukemia (CLL). Most of the literature, however, consists of isolated case reports or small case series. The aim of this retrospective study was to review the national experience with insect-bite-like reaction in a large group of patients with CLL. The study cohort of patients with these skin reactions consisted of 48 patients (25 males, 23 females) of mean age 64.8 yr (range 33-89) at skin eruption. Data on clinical, histologic, immunophenotypic, and cytogenetic characteristics, treatment, and outcome were collected from the medical files. Mean time between diagnosis of CLL and appearance of the skin lesions was 3.1 yr (range -4 to 14 yr). The eruption was not related to disease activity or the course of the hematological disease. The eruption preceded the diagnosis of CLL in 10 patients (by 0-4 yr); and followed the diagnosis in 36; in 11 patients, it occurred during therapy for CLL and in nine after therapy. Mean duration of the skin findings was 21.5 months (range 0.3-132). The eruption usually presented in summer, although it occurred also at other times of the year, and predominantly affected the upper and lower limbs, although it also appeared on unexposed areas. Treatment included local ointments, antihistaminics, oral steroids, antibiotics, phototherapy, and dapsone with varying responses. Insect-bite-like reactions is a relatively common and disturbing skin reaction in CLL patients, it may be related to the immune dysregulation accompanying CLL and further exacerbated by external factors, including actual insect bites, chemoimmunotherapy, and pyogenic infection.
authors.affiliation: Hematology Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. obairey@post.tau.ac.il
authors.forename: Osnat
authors.initials: O
authors.lastname: Bairey
authors.forename: Neta
authors.initials: N
authors.lastname: Goldschmidt
authors.forename: Rosa
authors.initials: R
authors.lastname: Ruchlemer
authors.forename: Tamar
authors.initials: T
authors.lastname: Tadmor
authors.forename: Neomi
authors.initials: N
authors.lastname: Rahimi-Levene
authors.forename: Mona
authors.initials: M
authors.lastname: Yuklea
authors.forename: Lev
authors.initials: L
authors.lastname: Shvidel
authors.forename: Alain
authors.initials: A
authors.lastname: Berrebi
authors.forename: Aaron
authors.initials: A
authors.lastname: Polliack
authors.forename: Yair
authors.initials: Y
authors.lastname: Herishanu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005076:Exanthema / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D016130:Immunophenotyping; D007299:Insect Bites and Stings / Q000175:diagnosis*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D012189:Retrospective Studies; D012871:Skin Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D006633:Histamine Antagonists; D013256:Steroids