P010 Eosinophilic dermatosis of haematological malignancy mimicking insect bite-like reaction in a patient with chronic lymphocytic leukaemia: a case report..
Published Date: 28th June 2024
Publication Authors: Nallathamby. K, Moss. K
Abstract:
We present a case of a patient presenting with severe insect bite-like reactions in her skin with underlying chronic lymphocytic leukaemia (CLL). A 71-year-old woman was diagnosed with CLL in 2017 after presenting with a low-level lymphocytosis. She has never required treatment for CLL and remains under active observation in the haematology clinic. She was initially referred to dermatology 5 years ago with a nonresolving insect bite-like rash on her chest. The biopsy of the lesion was thought to be reactive with CLL infiltration. Over the years she has had a number of flare-ups of differing severity; the rash has always been itchy, and she has often presented with tense vesiculobullous lesions, occasionally haemorrhagic in appearance. Multiple biopsies were taken over a period of 5 years due to the diagnostic challenge, with the main differentials being urticarial vasculitis, insect bite-like reactions, Wells syndrome/dermal hypersensitivity reaction and Churg–Strauss syndrome. One of the common trends with the patient’s rash and blistering lesions is that they have often flared up during the summer, during gardening or travelling, and she has also reported them after receiving the COVID-19 vaccine. There was no reaction following the flu vaccine. Biopsies were always negative for direct immunofluorescence, ruling out immunobullous reactions. There was often the presence of a heavy neutrophilic infiltrate, vascular inflammation, and vague granulomata with absence of frank vasculitis. Following multidisciplinary team discussion and close clinicopathological correlation, we have concluded that this could be eosinophilic dermatosis of haematological malignancy mimicking insect bites, of which only a few reported cases have been documented. This case report reviews the association between CLL and insect bite-like reaction and highlights the challenges associated with diagnosing and managing such dermatological manifestations. Previous literature showed no clear association with regards to treatment of CLL causing regression of the dermatological manifestation. The treatment is difficult and recurrences are common (Rodríguez-Lojo R, Almagro M, Piñeyro F et al. Eosinophilic panniculitis and insect bite-like eruption in a patient with chronic lymphocytic leukaemia: a spectrum of the same entity. Dermatol Res Pract 2010; 2010: 263827). In our case, the plan is to actively treat the underlying haematological malignancy and to assess the possibility of bringing the cutaneous manifestation under control. This case also highlights the lack of tailored therapeutic strategies for patients with CLL, in the context of its diverse and complex dermatological presentation.
Nallathamby, K; Moss, K; Et al. (2024). P010 Eosinophilic dermatosis of haematological malignancy mimicking insect bite-like reaction in a patient with chronic lymphocytic leukaemia: a case report.. British Journal of Dermatology. 191(Sup 1), p.i19. [Online]. Available at: https://doi.org/10.1093/bjd/ljae090.037 [Accessed 14 August 2024].