Insect Bite–like Reaction in Patients With Hematologic Malignant Neoplasms

Abstract

Background: Exaggerated reaction to insect bites, mainly to mosquitoes, is infrequently described in patients with chronic lymphocytic leukemia. Skin lesions usually appear months to years after the diagnosis of leukemia and are unrelated to laboratory findings, disease course, or therapy.Observations: We describe 8 patients with various hematologic disorders (chronic lymphocytic leukemia, acute lymphoblastic leukemia, acute monocytic leukemia, mantle-cell lymphoma, large-cell lymphoma, and myelofibrosis) who developed insect bite-like reaction. Although the clinical picture and the histological characteristics of the lesions were typical for insect bites, none of the patients actually had a history, course, or response to treatment suggestive of arthropod assaults. In 2 patients, the eruption preceded the diagnosis of the ma-lignant neoplasm. The rash persisted for months to years and was resistant to therapies other than systemic corticosteroids. The 3 patients with chronic lymphocytic leukemia seemed to have a worse prognosis than expected for their disease. In 1, the polymerase chain reaction detected leukemic cells in the infiltrate.Conclusions: Insect bite-like reaction is an infrequent, disturbing, and difficult-to-treat nonspecific phenomenon in patients with hematologic malignant neoplasms. Since it may precede the hematologic disorder, oriented evaluation is warranted. We speculate that immunodeficiency plays a role in its pathogenesis; however, the exact pathogenesis and its prognostic implications await further studies.

Cutaneous presentation of ALK-positive anaplastic large cell lymphoma following insect bites: evidence for an association in five cases

“…This same phenomenon was subsequently reported not only in patients with chronic lymphocytic leukemia, but also in patients with other lymphoproliferative diseases. 20 However, as only few patients recalled arthropod assaults, the role of insect bites in the initiation of such eruptions has remained controversial and the term "insect bite-like reaction" has been proposed. 20 Another example of the role of insect bites in lymphoproliferative disorders is the syndrome of hypersensitivity to insect bites associated with chronic active Epstein-Barr virus infection.…”

“…20 However, as only few patients recalled arthropod assaults, the role of insect bites in the initiation of such eruptions has remained controversial and the term "insect bite-like reaction" has been proposed. 20 Another example of the role of insect bites in lymphoproliferative disorders is the syndrome of hypersensitivity to insect bites associated with chronic active Epstein-Barr virus infection. [21][22][23] In this syndrome, CD4 + T cells stimulated by mosquito antigens may reactivate latent EpsteinBarr virus infection in NK/T cells and contribute to their unregulated expansion within inflammatory skin lesions and in the peripheral circulation.…”

Chronic Paraneoplastic Cutaneous Syndrome Preceding an Indolent Variant of Mantle Cell Lymphoma: Favorable Response to Rituximab

“…However, the clinical and histological features in our patient are not compatible with any of these disorders. Barzilai et al [15] described 8 patients with various hematologic malignancies, including 1 patient with MCL who developed insect bite-like reactions in the absence of a history of insect exposure. In 2 of these cases, the eruptions preceded the diagnosis of malignancy.…”

Exaggerated arthropod assault: Eosinophilic dermatosis in a patient with small lymphocytic lymphoma

“…In the case of CLL, the pathophysiology is yet to be fully understood; however, it is thought to occur as the result of a type IV delayed hypersensitivity reaction, as the cutaneous lesions are rich in T cells in addition to eosinophils, leading to the hypothesis that such a reaction represents an exaggerated response to arthropod bites 2, 4, 5, 6, 8. This was illustrated in a case of 8 patients with CLL who developed significant dermal reactions from exposure to mosquito antigen versus control patients 9.…”