Eosinophilic dermatosis of hematologic malignancy mimicking varicella zoster infection: report in a woman with chronic lymphocytic leukemia and review of the literature

Abstract

Eosinophilic dermatosis of hematologic malignancy is a rare papulovesicular eruption that presents in patients with hematoproliferative disorders, particularly chronic lymphocytic leukemia. A 59-year-old woman with chronic lymphocytic leukemia who developed eosinophilic dermatosis of hematologic malignancy mimicking varicella zoster infection is described. PubMed database was searched with the key words: chronic, dermatosis, eosinophilic, hematologic, infection, leukemia, lymphocytic, malignancy, varicella, zoster. The papers generated by the search and their references were reviewed. The patient presented, on more than 20 occasions, with a dermatomal vesicular eruption. Her oncologist, based on the clinical presentation, treated each episode as recurrent varicella zoster virus infection. A complete workup of the patient not only demonstrated negative viral studies but also revealed pathologic changes consistent with eosinophilic dermatosis of hematologic malignancy on lesional skin biopsy. The recurrence of the patient’s dermatosis was less frequent when her malignancy was under better control. Eosinophilic dermatosis of hematologic malignancy may mimic other reactive dermatoses. The morphology of our patient’s recurrent dermatosis resembled varicella zoster virus infection. Disseminated zoster virus infection with dermatomal and non-dermatomal distribution should be added to the clinical differential diagnosis of eosinophilic dermatosis of hematologic malignancy.

Lenalidomide in the management of eosinophilic dermatosis of hematological malignancy

“…The clinical findings are pruritic, frequently tender papules, nodules and vesicles/bullae resembling insect bites occurring on both sun‐exposed and non‐exposed areas of the body. A linear pattern of the lesions can be observed in some cases like described by Lucas‐Truyols et al ., and even mimic a varicella zoster infection like in the patient of Cohen et al . In our patient, the lesions were localized on the back following Langer's lines, in a distribution known as Christmas tree pattern.…”

Eosinophilic dermatosis of hematologic malignancy: Correlation of molecular characteristics of skin lesions and extracutaneous manifestations of hematologic malignancy

“…CLL, chronic lymphocytic leukemia contrast to specific cutaneous lesions, referred to as leukemia cutis 2,3,20. ED is most often associated with CLL,12,17 but has also been reported in patients with other hematologic neoplasias mainly of B-cell origin 8,12,15,17. As observed in our cases, diagnosis of underlying hematologic disease usually precedes the onset of ED and accurate diagnosis of ED is commonly delayed by months resulting in impaired quality of life 13.…”

“…Diagnostic criteria were defined by Byrd et al and are based on clinical (insect bite‐like eruption, refractory to standard therapies) and histological (superficial and deep lymphohistiocytic infiltrate with abundant eosinophils) criteria as well as on the patients' medical history (underlying hematological disease, exclusion of other reasons for tissue eosinophilia). Until 2012, approximately 40 to 50 cases of ED had been published in case reports and small case series . Bairey et al reported 48 patients with ED in a cohort of CLL patients in a retrospective study of the Israeli CLL Study Group.…”

“…Until 2012, approximately 40 to 50 cases of ED had been published in case reports and small case series. 12 Bairey et al 13 reported 48 patients with ED in a cohort of CLL patients in a retrospective study of the Israeli CLL Study…”

Hematologic-Related Malignancy-Induced Eosinophilic Dermatosis (He Remained): An eosinophilic dermatosis predominantly associated with chronic lymphocytic leukemia

“…To the Editor: I read with interest the enlightening research letter by Grandi et al 1 and the accompanying astute clinician's perspective by Heymann,2 which summarize many of the salient features of a paraneoplastic dermatosis that is characterized by recurrent episodes of pruritic erythematous lesions-ranging from papules and nodules to urticarial plaques and blisters-that show prominent dermal eosinophilia. 3,4 The world literature on eosinophilic dermatosis of hematologic malignancy (EDHM) was recently reviewed 5 ; to the best of my knowledge, 206 patients with this condition have been described (Table I). [3][4][5][6][7] EDHM has been observed more frequently in men (55% [107 of 193 patients]) than in women (45% [86 of 193 patients]); sex was not provided for 13 patients.…”