Eosinophilic Dermatosis of Myeloproliferative Disease in a Young Adult With Diffuse Large B-Cell Lymphoma

Abstract

Exaggerated insect bite reactions present as exuberant papular and vesiculobullous lesions in patients with hematologic malignant neoplasms. The most commonly reported hematological malignancy with exaggerated insect bite reactions is chronic lymphocytic leukemia. Other reported reactions have been seen in patients with mantle cell lymphoma. Clinical presentation may vary with many patients unaware of a previous insect bite. Therefore, the terms “exaggerated bite-like reaction” and “eosinophilic dermatosis of myeloproliferative disease” have been proposed. The lesions may wax and wane or persist for many years, and they seem to be unrelated to the underlying hematologic disorder course or therapy. In some circumstances, the lesions may actually precede the diagnosis of the hematological malignancy. In this study, we describe a case of “eosinophilic eruption of myeloproliferative disease” associated with diffuse large B-cell lymphoma in a young adult. To the best of our knowledge, this is the first case reported in association with diffuse large B-cell lymphoma.

Eosinophilic folliculitis, eosinophilic dermatosis of hematologic malignancy and acneiform follicular mucinosis: Two case reports and a review of the literature highlighting the spectrum of histopathology

“…Muñoz‐Aceituno et al recently categorized overlapping follicular mucinosis and EF in patients with human immunodeficiency virus with an emphasis on their co‐occurrence as a plausible concomitant reactive pattern 37 . Further, both EDHM and EF have been associated with dense T‐cell infiltrates with increased CD4:CD8 ratios, though reports indicate retention of other T‐cell markers, similar to our case 5,20 . We also considered that the altered CD4:CD8 ratio may have occurred secondary to drug effect in our first patient due to rituximab's ability to alter T‐cell counts in other conditions 38 .…”

“…EF presents with erythematous pruritic papules, vesicles, micropustules, and urticarial plaques on the face, neck, torso, and extremities (Table 1). 2,3,5‐22 Histopathological findings in EF have been described to include a mixed dermal lymphocytic infiltrate with eosinophils that involves the follicular epidermis with spongiosis. Interestingly, Bull and Motaparthi have also described follicular mucin deposition as a component of EF 2,6 .…”

“…EDHM, originally described as insect bite‐like reaction and subsequently given numerous other terms including eosinophilic dermatosis of myeloproliferative disease, was originally described by Weed and later reported by Byrd to include patients with a history of myeloproliferative disorder or hematologic malignancy with specific histopathological findings (superficial and deep lymphocytic infiltrate with eosinophils) in the absence of a known history of insect bite 12,23 . EDHM has been reported predominantly in patients with CLL as well as numerous other hematologic malignancies and proliferative disorders 12‐23 . Although clinical presentations vary, EDHM has been characterized by a pruritic eruption of papules, plaques, and nodules on the extremities with the torso, head, and neck variably involved (Table 1).…”

Secondary cutaneous diffuse large B-cell lymphoma presenting with focal vesicular lesions

“…An association of blistering diseases with DLBCL has been described with a paraneoplastic pemphigus-like eruption with negative autoantibodies [4]. Eosinophilic dermatosis of myeloproliferative disease presenting with edematous nodules with central vesicular eruption was reported once in a patient with stage IV systemic DLBCL [5]. Our patient had a history of systemic DLBCL that later spread to involve the skin in which the vesicles were located only on the indurated erythematous nodules involved by DLBCL.…”

Immune-Mediated Dermatoses in Patients with Haematological Malignancies: A Comprehensive Review

“…Besides B-cell chronic lymphatic leukaemia, where EDHM is estimated to affect 6-8% of patients, and B-cell lymphoproliferative disorders, EDHM can also occur in association with other HMs, such as T-cell lymphomas, acute leukaemia, chronic myeloproliferative disorders and plasma cell dyscrasias [103,105,108,109]. The disease usually manifests months to years after the diagnosis of the HM; however, a minority of patients experienced the skin eruption up to 10 years prior to the haematological diagnosis [105,110].…”