Eosinophilic folliculitis in a patient with chronic myelomonocytic leukemia

Oum, Phalyka; Satcher, Kerrie G.; Braswell, Diana; Montanez‐Wiscovich, Marjorie; Motaparthi, Kiran

doi:10.1016/j.jdcr.2019.05.021

Cited by 2 publications

(6 citation statements)

References 9 publications

(23 reference statements)

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“…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 .…”

Section: Discussionmentioning

confidence: 58%

“…It is likely that these similar cutaneous processes represent a continuum of manifestations of reactive changes associated with hematologic malignancies. Of note, Oum and Motaparthi have similarly contended that the overlapping clinical and histopathological features of EF and EDHM may represent a spectrum of the same process 5 . Heymann, likewise, posits this concept and further suggests that these phenomena are likely more prevalent than current estimates 41 .…”

Section: Discussionmentioning

confidence: 99%

“…EF, alternatively termed eosinophilic pustular folliculitis, was originally described by Ofuji as a noninfectious follicular infiltrate without associated malignancy. Understanding of the variants of this diagnosis has evolved over time and the histopathological pattern has been described in association with CLL and acute myelogenous leukemia, among others 1‐10 . EF presents with erythematous pruritic papules, vesicles, micropustules, and urticarial plaques on the face, neck, torso, and extremities (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…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 .…”

Section: Discussionmentioning

confidence: 99%

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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

Bailey

Laurain²,

Sheinbein³

et al. 2020

J Cutan Pathol

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Within the literature, there is overlap in the histopathological features described in eosinophilic folliculitis associated with chronic lymphocytic leukemia (CLL), eosinophilic dermatosis of hematologic malignancy, and acneiform follicular mucinosis. These disorders are described with varying degrees of superficial and deep lymphocytic and eosinophilic inflammation demonstrating perivascular, perifollicular, and folliculocentric involvement with or without follicular mucin deposition. Given significant histopathological overlap, these diagnoses may represent a continuum on a spectrum of dermatoses. Here, we present two cases with histopathological elements that reflect components of this clinicopathological spectrum and compare our findings with previously reported cases to compare and contrast reported features. Our first case is a 71‐year‐old African American man with long‐standing CLL who developed a pruritic erythematous papular eruption on the face and chest with biopsy revealing a dense folliculotropic lymphocytic infiltrate with conspicuous eosinophils and follicular mucinosis. Our second case is a 70‐year‐old Caucasian man recently diagnosed with CLL/small lymphocytic lymphoma who developed an erythematous papular rash on the neck and face with biopsy revealing superficial and deep perivascular and periadnexal lymphocytic inflammation with scattered eosinophils. Characterization of our two cases and comparison with available literature suggest that these disorders may represent a continuum of dermatoses.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Bailey

Laurain²,

Sheinbein³

et al. 2020

J Cutan Pathol

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“…Although more commonly associated with HIV, a subset of patients with eosinophilic folliculitis, which can resemble EDHM clinically and histologically, have concomitant haematological malignancy 19 . The folliculocentric nature, both of the clinical lesions and histological eosinophilic infiltrate, enables distinction 20 …”

Section: Discussionmentioning

confidence: 99%

Eosinophilic dermatosis of haematological malignancy (EDHM): A series of nine cases

Bakr

Costa

Cabeçadas

et al. 2022

JEADV Clinical Practice

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Background Nonspecific cutaneous eruptions in patients with haematological malignancies are not uncommon. Eosinophilic dermatosis of haematological malignancy (EDHM), previously known as an ‘insect bite‐like’ reaction, has been reported in a wide range of haematological malignancies, most commonly chronic lymphocytic leukaemia. Its exact pathogenetic mechanism is unclear. Objectives To further characterise this eruption, review the literature of this rare condition and discuss its nosological status with respect to several differential diagnoses. Methods Nine patients with a diagnosis of EDHM were identified retrospectively and the clinical and histological features were reviewed. Results The morphology of the cutaneous eruptions varied between patients with macules, papules, nodules, vesicles or bullae all reported. Eight out of the nine cases had a known underlying malignancy. The cutaneous eruption preceded and led to the diagnosis of a splenic marginal zone lymphoma in one patient. Eosinophils were identified in all histological specimens. Other common features included bullae, lymphocytic infiltrates and apoptotic keratinocytes. CD20(+) B‐cells were only observed in one case. Conclusions We present a series of nine patients with EDHM associated with a range of haematological malignancies and with varied clinical presentations. The histological features however were consistent. We postulate potential mechanisms underlying the pathogenesis of this uncommon condition, which is most likely due to a dysregulated immune system driving a T‐cell and eosinophil‐mediated hypersensitivity reaction.

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Eosinophilic folliculitis in a patient with chronic myelomonocytic leukemia

Cited by 2 publications

References 9 publications

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

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

Eosinophilic dermatosis of haematological malignancy (EDHM): A series of nine cases

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