Cutaneous lymphoid hyperplasia induced by Hirudo medicinalis (leeches)

Abstract

For centuries, Hirudo medicinalis (medicinal leech) has been used as a remedy to treat many discomforts, such as muscle and joint pain. Nowadays, using leech in reconstructive surgery, microsurgery, wound and flap healing, venous insufficiency, varicosities and many other disorders has increased. In this study, we report a 45 year old female patient with six pruritic papules on her legs since10 months ago that appeared about 4 weeks after one session of leech application. Skin biopsy was performed on one of the papules, and in histopathology, superficial ulceration with a dense superficial and deep inflammatory infiltrate within the dermis composed of lymphocytes and eosinophils detected that considering history of leech application at this site, these constellation of data was compatible with the diagnosis of cutaneous lymphoid hyperplasia induced by leeches and the patient was cured by a topical steroid and cryotherapy.

Cutaneous Pseudolymphoma As a Rare Adverse Effect of Medicinal Leech Therapy: A Case Report and Review of the Literature

“…Pseudolymphoma at the site of leech therapy is mostly presented in the form of firm, erythematous, brown or purple nodules, or papules; however, the lesions are rarely presented as plaques [ [4][5][6][7][8][9]7,11,10]. Some studies reported pruritus as a symptom of pseudolymphoma following leech therapy [7][8][9][10][11]. In the case of our patient, the lesions were pruritic papules.…”

“…Persistent bite reaction frequently occurs following scabies and less commonly other arthropod bites. Few cases of pseudolymphomatous bite reaction have been reported after medicinal leech therapy [5][6][7][8][9][10][11]. Table 1 summarizes the features of the cases of cutaneous pseudolymphoma after medicinal leech therapy reported in the English language studies indexed in PubMed and Google Scholar.…”

“…Table 1 summarizes the features of the cases of cutaneous pseudolymphoma after medicinal leech therapy reported in the English language studies indexed in PubMed and Google Scholar. Most of the reported cases of leech-induced pseudolymphoma have been female patients [4,[6][7][8][9]11]. Most of the cases have tried it as a treatment for a medical problem including venous insufficiency, back pain, uterine myoma, and fibromyalgia [4,[6][7][8][9]11].…”

“…Previous studies have reported various time lapses between leech therapy and the appearance of pseudolymphoma, including several weeks to several months [4][5][6][7]10,11]. Pseudolymphoma at the site of leech therapy is mostly presented in the form of firm, erythematous, brown or purple nodules, or papules; however, the lesions are rarely presented as plaques [ [4][5][6][7][8][9]7,11,10]. Some studies reported pruritus as a symptom of pseudolymphoma following leech therapy [7][8][9][10][11].…”

“…Pseudolymphomatous reaction to leech bites was first described by Smolle et al in 2000 [4]. To the best of our knowledge, English language studies have presented seven other cases so far [5][6][7][8][9][10][11]. Herein, a new case of cutaneous pseudolymphoma is presented at the site of medicinal leech therapy.…”