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Tan S, Choong DJ, Tan E. A systematic review of the management of eosinophilic dermatosis of hematological malignancy. Int J Dermatol 2024; 63:1164-1171. [PMID: 38727148 DOI: 10.1111/ijd.17221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 09/01/2024]
Abstract
Eosinophilic dermatosis of hematologic malignancy (EDHM) is a cutaneous manifestation seen in patients with hematoproliferative and lymphoproliferative disorders, most commonly chronic lymphocytic leukemia. This systematic review aimed to summarize the therapeutic interventions of EDHM. A comprehensive search yielded 71 studies, predominantly case reports and series. The most frequently reported modalities were systemic and topical corticosteroids, as well as treatment of the underlying malignancy. Responses to these treatments varied. Targeted therapies, including dupilumab and omalizumab, showed promise, as did other modalities such as montelukast, dapsone, doxycycline, and phototherapy. Higher-quality studies should be conducted to facilitate higher-quality management recommendations for EDHM.
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Affiliation(s)
- Stephanie Tan
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Dean Jeremy Choong
- Western Australian Faculty, The Australasian College of Dermatologists, St. Leonards, NSW, Australia
- Fiona Stanley Fremantle Hospital Group, Murdoch, WA, Australia
| | - Ernest Tan
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Western Australian Faculty, The Australasian College of Dermatologists, St. Leonards, NSW, Australia
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2
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Michelerio A, Rubatto M, Roccuzzo G, Coscia M, Quaglino P, Tomasini C. Eosinophilic Dermatosis of Hematologic Malignancy: Emerging Evidence for the Role of Insect Bites-A Retrospective Clinico-Pathological Study of 35 Cases. J Clin Med 2024; 13:2935. [PMID: 38792476 PMCID: PMC11121821 DOI: 10.3390/jcm13102935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Eosinophilic dermatosis of hematologic malignancy (EDHM) is a rare cutaneous disorder associated with various hematologic malignancies, most commonly chronic lymphocytic leukemia. Detailed clinicopathologic studies of EDHM are lacking and the pathogenesis remains enigmatic. Initially thought to be a hypersensitivity reaction to insect stings, subsequent reports have challenged this understanding. The prognostic implications of EDHM remain unclear. Methods: A retrospective clinicopathologic study was performed on patients diagnosed with EDHM. Hematologic and dermatologic data were reviewed. Histologic specimens were re-evaluated and lesions were classified into acute/subacute, fully developed, and chronic/regressing. Results: The study included 35 patients. In 80% of these patients, EDHM was diagnosed after the hematologic disorder. Approximately 45% of the cohort experienced hematologic disease progression or relapse, while 65% required therapeutic intervention during the course of their hematologic disease. In total, 15/19 CLL patients had non-mutated IgHV, a marker of a more aggressive hematologic disease course. Dermatologic lesion morphology was heterogeneous, with most lesions occurring on exposed areas, and a significant 94% of patients demonstrated lesion seasonality. Histopathologic findings were consistent with features typically associated with insect bites. In addition, examination of lesions at different chronological stages revealed substantial similarities with Wells syndrome. Conclusions: Our findings support the potential role of insect bites in triggering EDHM in the context of adaptive immune dysfunction. EDHM may be associated with a more aggressive disease course or may be a marker of disease progression. The observed co-occurrence of features typical of Wells syndrome in EDHM patients suggests that these conditions are part of a spectrum of disorders that vary in clinical expression.
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Affiliation(s)
- Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Marco Rubatto
- Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy
| | - Gabriele Roccuzzo
- Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, 10126 Turin, Italy
| | - Carlo Tomasini
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Radonjic-Hoesli S, Martignoni Z, Cazzaniga S, Furrer DI, Simon HU, Bürgler C, Simon D. Characteristics of Dermatological Patients With Blood Eosinophilia: A Retrospective Analysis of 453 Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1229-1237.e8. [PMID: 35247633 DOI: 10.1016/j.jaip.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Skin diseases associated with blood or tissue eosinophilia are common. Because these have various clinical manifestations, making the correct diagnosis can be challenging. So far, dermatological patients with concomitant blood eosinophilia have not been characterized. OBJECTIVE To investigate patterns of dermatological patients with concomitant blood eosinophilia to obtain information helpful for optimizing disease management. METHODS In this retrospective study, demographic and clinical data and diagnostic test results of all patients presenting with dermatoses associated with blood eosinophilia referred to a university center from 2014 to 2018 were extracted from the electronic patient charts and evaluated using descriptive and semantic map analyses. RESULTS A total of 453 patients (51.4% females; mean age, 58.4 ± 21.7 years) were included and grouped according to blood absolute eosinophil counts: severe, greater than or equal to 1.5 G/L (n = 87; 19.2%); moderate, 1.0 to 1.49 G/L (n = 73; 16.1%); and mild eosinophilia, 0.5 to 0.99 G/L (n = 293; 64.7%). Most patients presented with chronic (64.6%), generalized skin lesions (75.9%), and pruritus (88.1%). Statistical analyses revealed 3 distinct patterns: (1) mild eosinophilia associated with localized skin disease, age less than 50 years, history of atopy, and diagnosis of eczema or infectious disease; (2) moderate eosinophilia linked to generalized skin lesions, pruritus, age more than 70 years, and autoimmune bullous disease; and (3) severe eosinophilia associated with diagnosis of hypereosinophilic syndromes, drug hypersensitivity, or malignant disease. CONCLUSIONS Based on the pattern analysis of patients with dermatoses associated with blood eosinophilia, a diagnostic workup has been developed aiming at setting the correct differential diagnosis in a feasible and effective manner.
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Affiliation(s)
- Susanne Radonjic-Hoesli
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zora Martignoni
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Centro Studi GISED, Bergamo, Italy
| | - Dominique Isabel Furrer
- Insel Data Science Center, Directorate of Teaching and Research, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland; Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia; Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Institute of Biochemistry, Brandenburg Medical School, Neuruppin, Germany
| | - Christina Bürgler
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Radonjic-Hoesli S, Brüggen MC, Feldmeyer L, Simon HU, Simon D. Eosinophils in skin diseases. Semin Immunopathol 2021; 43:393-409. [PMID: 34097126 PMCID: PMC8241748 DOI: 10.1007/s00281-021-00868-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
Eosinophil infiltration is a common finding in a broad spectrum of skin diseases, despite the fact that the skin is devoid of eosinophils under physiologic conditions. Although cutaneous eosinophilia is reactive, cytokine-mediated in most cases, diseases with an intrinsic mutation-mediated clonal expansion of eosinophils can also manifest on the skin. As eosinophils are involved in host defense, regulate immune responses, generate pruritus, induce remodeling and fibrosis, and can cause tissue damage, they have the capacity to actively contribute to the pathogenesis of diseases. Recent research provided deeper insights in the mechanisms, e.g., bacterial and viral clearance, blister formation, recruitment of cytotoxic T cells, and generation of pruritus, by which eosinophils might come into action. This review aims at providing an overview on the clinical presentations of eosinophil-associated dermatoses and the current understanding of their pathogenic role in these diseases. Further, we discuss the effects of therapies targeting eosinophils.
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Affiliation(s)
- Susanne Radonjic-Hoesli
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Charlotte Brüggen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Department of Dermatology, Hochgebirgsklinik Davos, Davos, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Sato-Sano M, Teixeira SP, Vargas JC, Baiocchi OCCG, Enokihara MMSES, Gomes EE, Batista MD. Lenalidomide in the management of eosinophilic dermatosis of hematological malignancy. J Dermatol 2019; 46:618-621. [PMID: 31144726 DOI: 10.1111/1346-8138.14916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 04/12/2019] [Indexed: 11/28/2022]
Abstract
Eosinophilic dermatosis of hematological malignancy is a paraneoplastic skin eruption associated with chronic lymphocytic leukemia and other B-cell malignancies. It clinically resembles an insect bite reaction and it can precede the symptoms of the hematological malignancy or be related to a more aggressive course. Different treatments have been proposed, but partial response and recurrence are frequent. Herein, we describe a case of eosinophilic dermatosis associated with mantle cell lymphoma with remission after lenalidomide therapy.
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Affiliation(s)
- Marcelo Sato-Sano
- Department of Dermatology, Federal University of Sao Paulo, Sao Paulo, Brazil.,Oncology Center, Portuguese Beneficence of São Paulo, Sao Paulo, Brazil
| | | | - Juliano Cordova Vargas
- Department of Clinical and Experimental Oncology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Milvia Maria Simões E Silva Enokihara
- Department of Dermatology, Federal University of Sao Paulo, Sao Paulo, Brazil.,Department of Pathology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Mariana Dias Batista
- Department of Dermatology, Federal University of Sao Paulo, Sao Paulo, Brazil.,Oncology Center, Portuguese Beneficence of São Paulo, Sao Paulo, Brazil
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Darji K, Bahram-Ahi E, Dhandha M, Guo M. Mantle cell lymphoma presenting with exaggerated skin reaction to insect bites. BMJ Case Rep 2019; 12:12/3/e227590. [PMID: 30902840 DOI: 10.1136/bcr-2018-227590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 62-year-old African-American woman with medical history of hypertension and hyperlipidaemia who presented to dermatology clinic for 'bug bites'. Skin examination showed resolving bullae on the shins and postinflammatory pigment changes. Histopathology showed eosinophilic spongiosis and direct immunofluorescence (DIF) was negative for IgG, IgM, IgA and C3. After returning to clinic with recurrent severe bullous eruptions, the patient presented with anaemia, lymphocytosis, posterior cervical lymphadenopathy and weight loss. An exuberant bite reaction in the setting of lymphoma was suspected. Further workup with haematology revealed elevated IgG level and total protein levels. Flow cytometry showed a B cell lymphoma subtype. Extensive imaging was positive for diffuse lymphadenopathy, with accompanying evidence of Ebstein-Barr virus infection. Our case highlights the importance of considering exuberant arthropod bite reaction in the setting of undiagnosed lymphoma in a patient with bullous eruption and negative DIF.
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Affiliation(s)
- Kavita Darji
- Department of Dermatology, Saint Louis University Hospital, Saint Louis, Missouri, USA
| | - Emily Bahram-Ahi
- Department of Internal Medicine, Saint Louis University Hospital, Saint Louis, Missouri, USA
| | - Maulik Dhandha
- Department of Dermatology, MDFMR Dermatology Services, Augusta, Maine, USA
| | - Mary Guo
- Department of Dermatology, Saint Louis University Hospital, Saint Louis, Missouri, USA
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7
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Visseaux L, Durlach A, Barete S, Beylot-Barry M, Bonnet N, Chassine A, Franck N, Herve G, Leclec'h C, Machet L, Ingen-Housz-Oro S, Petrella T, Vergier B, Ortonne N, Grange F. T-cell papulosis associated with B-cell malignancy: a distinctive clinicopathologic entity. J Eur Acad Dermatol Venereol 2018; 32:1469-1475. [DOI: 10.1111/jdv.14805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Affiliation(s)
- L. Visseaux
- Service de Dermatologie; Hôpital Robert Debré; Reims France
| | - A. Durlach
- Laboratoire Pol Bouin; Hôpital Maison Blanche; Reims France
| | - S. Barete
- Service de Dermatologie; Hôpital Pitié-Salpêtrière; Paris France
| | - M. Beylot-Barry
- Service de Dermatologie; Hôpital Saint-André; Bordeaux France
| | - N. Bonnet
- Dermatologie; Institut Paoli Calmettes; Marseille France
| | | | - N. Franck
- Service de Dermatologie; Hôpital Cochin; Paris France
| | - G. Herve
- Service de Pathologie; Hôpital Pitié-Salpêtrière; Paris France
| | - C. Leclec'h
- Service de Dermatologie; CHU d'Angers; Angers France
| | - L. Machet
- Service de Dermatologie; Hôpital Trousseau; Tours France
| | | | - T. Petrella
- Department of Hematology-Oncology; University of Montréal; Montréal Canada
| | - B. Vergier
- Service de Pathologie; Hôpital Haut-Levêque; Pessac France
| | - N. Ortonne
- Service de Pathologie; Hôpital Henri Mondor; Créteil France
| | - F. Grange
- Service de Dermatologie; Hôpital Robert Debré; Reims France
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8
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Lucas-Truyols S, Rodrigo-Nicolás B, Lloret-Ruiz C, Quecedo-Estébanez E. Dermatosis eosinofílicas asociadas a procesos hematológicos. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:e39-e44. [DOI: 10.1016/j.ad.2016.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/15/2016] [Accepted: 10/09/2016] [Indexed: 10/19/2022] Open
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9
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Eosinophilic Dermatosis of Hematologic Malignancy. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Jayasekera PS, Bakshi A, Al-Sharqi A. Eosinophilic dermatosis of haematological malignancy. Clin Exp Dermatol 2016; 41:692-5. [PMID: 27378400 DOI: 10.1111/ced.12846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P S Jayasekera
- Department of dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - A Bakshi
- Department of histopathology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - A Al-Sharqi
- Department of dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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11
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Les dermatoses éosinophiliques. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.01.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Bairey O, Goldschmidt N, Ruchlemer R, Tadmor T, Rahimi-Levene N, Yuklea M, Shvidel L, Berrebi A, Polliack A, Herishanu Y. Insect-bite-like reaction in patients with chronic lymphocytic leukemia: a study from the Israeli Chronic Lymphocytic Leukemia Study Group. Eur J Haematol 2012; 89:491-6. [PMID: 23033927 DOI: 10.1111/ejh.12015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 01/28/2023]
Abstract
An insect-bite-like reaction is known to occur in patients with chronic lymphocytic leukemia (CLL). Most of the literature, however, consists of isolated case reports or small case series. The aim of this retrospective study was to review the national experience with insect-bite-like reaction in a large group of patients with CLL. The study cohort of patients with these skin reactions consisted of 48 patients (25 males, 23 females) of mean age 64.8 yr (range 33-89) at skin eruption. Data on clinical, histologic, immunophenotypic, and cytogenetic characteristics, treatment, and outcome were collected from the medical files. Mean time between diagnosis of CLL and appearance of the skin lesions was 3.1 yr (range -4 to 14 yr). The eruption was not related to disease activity or the course of the hematological disease. The eruption preceded the diagnosis of CLL in 10 patients (by 0-4 yr); and followed the diagnosis in 36; in 11 patients, it occurred during therapy for CLL and in nine after therapy. Mean duration of the skin findings was 21.5 months (range 0.3-132). The eruption usually presented in summer, although it occurred also at other times of the year, and predominantly affected the upper and lower limbs, although it also appeared on unexposed areas. Treatment included local ointments, antihistaminics, oral steroids, antibiotics, phototherapy, and dapsone with varying responses. Insect-bite-like reactions is a relatively common and disturbing skin reaction in CLL patients, it may be related to the immune dysregulation accompanying CLL and further exacerbated by external factors, including actual insect bites, chemoimmunotherapy, and pyogenic infection.
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Affiliation(s)
- Osnat Bairey
- Hematology Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
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Vonarx M, Carpentier O, Cazin B, Bouchindhomme B, Delaporte E. Leucémie lymphoïde chronique révélée par des infiltrats cutanés spécifiques en l’absence d’hyperlymphocytose : deux observations. Ann Dermatol Venereol 2012; 139:641-6. [DOI: 10.1016/j.annder.2012.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/05/2012] [Accepted: 06/28/2012] [Indexed: 10/27/2022]
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Abstract
Cutaneous involvement by an eosinophil-rich process (eosinophilic dermatosis) may be encountered in the setting of various hematologic malignancies, including mantle cell lymphoma, acute monocytic leukemia, acute lymphoblastic leukemia, large cell lymphoma, myelofibrosis and chronic lymphocytic leukemia (CLL). Of the various hematologic malignancies, eosinophilic dermatosis has been most frequently described in association with CLL. Published previously as insect bite-like reaction and eosinophilic dermatosis of myeloproliferative disease, this rare dermatitis presents as a pruritic, papular and occasionally vesicular eruption associated with an eosinophil-rich infiltrate histopathologically. Although clinical and histopathologic features are similar to insect bites, affected patients frequently deny a history of insect bites. We report a case of eosinophilic dermatosis of hematologic malignancy in a patient with known history of CLL.
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Affiliation(s)
- Michele J Farber
- Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Delaporte E. Avons-nous vraiment besoin de la « dermatose éosinophilique des hémopathies » ? Ann Dermatol Venereol 2010; 137:179-80. [DOI: 10.1016/j.annder.2010.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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