Kim Jee Eun, Kim Soo-Chan
Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Ann Dermatol. 2018 Aug;30(4):468-472. doi: 10.5021/ad.2018.30.4.468. Epub 2018 Jun 28.
Patients with chronic lymphocytic leukemia (CLL) rarely exhibit an exaggerated insect bite-like reaction without a history of an arthropod bite. We report a case of an insect bite-like reaction in a 74-year old man with CLL. The patient presented with a 2-year history of recurrent itchy erythematous patches and blisters on the whole body. He had been diagnosed with CLL 2 years ago, and the skin lesions developed 1 month after remission. The result of a skin biopsy was consistent with insect bite. Immunohistochemical staining of the infiltrated cells showed positive reactions for CD3, CD5 and negative for CD20, CD23. Direct and indirect immunofluorescence revealed negative results. The patient was treated with oral prednisolone and dapsone, under the diagnosis of CLL-associated insect bite-like reaction, and showed marked improvement. Dermatologist should be aware of insect bite-like reaction associated with CLL as a distinct disease entity that is similar to insect bite or bullous pemphigoid.
慢性淋巴细胞白血病（CLL）患者在无节肢动物叮咬史的情况下很少出现类似昆虫叮咬的过度反应。我们报告一例74岁CLL男性患者出现类似昆虫叮咬反应的病例。患者有2年全身反复出现瘙痒性红斑和水疱的病史。他2年前被诊断为CLL，皮肤病变在缓解后1个月出现。皮肤活检结果与昆虫叮咬相符。浸润细胞免疫组化染色显示CD3、CD5阳性，CD20、CD23阴性。直接和间接免疫荧光检查结果均为阴性。该患者被诊断为CLL相关的类似昆虫叮咬反应，接受口服泼尼松龙和氨苯砜治疗后症状明显改善。皮肤科医生应意识到CLL相关的类似昆虫叮咬反应是一种与昆虫叮咬或大疱性类天疱疮相似的独特疾病实体。
