1
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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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2
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Brun A, Ysebaert L, Oberic L, Lamant L, Sibaud V. Assessment of Seasonality in Eosinophilic Dermatosis of Haematological Malignancy. Acta Derm Venereol 2024; 104:adv15768. [PMID: 38372473 PMCID: PMC10896217 DOI: 10.2340/actadv.v104.15768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Aurore Brun
- Oncodermatology Department, Oncopole Claudius Regaud and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Loic Ysebaert
- Haematology department, Oncopole Claudius Regaud and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Lucie Oberic
- Haematology department, Oncopole Claudius Regaud and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Laurence Lamant
- Pathology department, Oncopole Claudius Regaud and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Vincent Sibaud
- Oncodermatology Department, Oncopole Claudius Regaud and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France.
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3
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Maronese CA, Derlino F, Moltrasio C, Cattaneo D, Iurlo A, Marzano AV. Neutrophilic and eosinophilic dermatoses associated with hematological malignancy. Front Med (Lausanne) 2024; 10:1324258. [PMID: 38249974 PMCID: PMC10796805 DOI: 10.3389/fmed.2023.1324258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Cutaneous manifestations of hematologic malignancy represent both a clinical challenge for the treating physician and a pathophysiological model for advancing the knowledge on individual neoplasms. Indeed, a growing body of evidence supports the concept of recurrent molecular defects associating with specific clinical features, as best exemplified by VEXAS. Herein neutrophilic and eosinophilic dermatoses of potential interest for both hematologists and dermatologists will be reviewed, including subcorneal pustular dermatosis-type IgA pemphigus, neutrophilic eccrine hidradenitis, Sweet's syndrome as well as myelodysplasia cutis and VEXAS, pyoderma gangrenosum, eosinophilic annular erythema, eosinophilic dermatosis of hematological malignancy, Wells syndrome and cutaneous involvement in hypereosinophilic syndromes. Possible management approaches are discussed for each, emphasizing scenarios that require treatment of the underlying condition to achieve remission at the skin level.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Federica Derlino
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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4
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Michelerio A, Tomasini C, Fiandrino G, De Amici M, Varettoni M, Defrancesco I, Cavalloni C, Brazzelli V, Derlino F, Paulli M, Arcaini L, Vassallo C. Eosinophilic dermatosis of hematologic malignancy in patients with chronic lymphocytic leukemia/non-Hodgkin's B lymphoma: a single center prospective clinico-pathological study. Front Med (Lausanne) 2023; 10:1231003. [PMID: 37614953 PMCID: PMC10442565 DOI: 10.3389/fmed.2023.1231003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
Background The pathogenesis of eosinophilic dermatosis of hematologic malignancy (EDHM) is poorly understood. Previously thought to be a hypersensitivity reaction to insect bites, immune dysregulation and cytokine imbalance are now thought to be responsible. Its prognostic significance is unclear. Objective To describe the clinical, pathological and immunological findings in a series of oncohematological patients with EDHM. Methods An observational prospective cohort study of oncohematological patients receiving a diagnosis of EDHM between April 2017 and December 2018. Results A total of 15 patients with EDHM (10 females and 5 males) were identified among 422 oncohematological patients. Disease presentation varied from firm erythematous papules to more polymorphic presentations. The lesions were most prevalent on the exposed sites, 8/15 patients recalled an insect bite. Lesion seasonality was reported in 13/15 patients. IgE levels were elevated in six patients, circulating IL-4 and IL-5 were within a normal range. Twelve out of 15 patients developed skin manifestations after chemotherapy. The infiltrate could be eosinophil-rich or lymphocytic-rich. Interestingly, the histopathologic findings were in accordance with arthropod bites. Conclusion A role for insect bites in EDHM is supported by our findings. EDHM may be related to aggressive hematologic disease.
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Affiliation(s)
- Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Tomasini
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Fiandrino
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mara De Amici
- Laboratory of Immuno-Allergology of Clinical Chemistry and Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marzia Varettoni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Irene Defrancesco
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cavalloni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Derlino
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Paulli
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Vassallo
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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5
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Pan S, Bicknell L. A Case of Eosinophilic Dermatosis of Hematologic Malignancy Treated With Narrow-Band Ultraviolet B (NBUVB). Cureus 2023; 15:e35734. [PMID: 37016657 PMCID: PMC10067021 DOI: 10.7759/cureus.35734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is one of the most common leukemias in adults. It has been associated with a number of dermatologic manifestations, such as leukemia cutis and erythema multiforme. Among the rarer of these findings is eosinophilic dermatosis of hematologic malignancy (EDHM). EDHM was originally characterized as a hypersensitive insect bite-like reaction, despite most patients having no distinct recollection of being bit or having any risk of exposure. Typically, EDHM presents as a pruritic, erythematous eruption, often with papulovesicular lesions, throughout the body. Due to its relapsing course, a number of treatment methods have been proposed, but no standard of care has been established. In this report, we present a recalcitrant case of EDHM in a patient with CLL that responded well to treatment with narrow-band ultraviolet B (NBUVB) light therapy.
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6
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Abbott J, Corean J, Snyder AM, Florell SR, Miles R, Stephens D, Wada DA. Folliculocentric lymphocytic hypersensitivity reactions in CLL/SLL patients: A unique clinicopathologic entity amongst non‐specific hypersensitivity reactions. SKIN HEALTH AND DISEASE 2023. [DOI: 10.1002/ski2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- James Abbott
- Department of Dermatology University of Utah Salt Lake City Utah USA
| | - Jessica Corean
- Department of Pathology University of Utah Salt Lake City Utah USA
| | - Ashley M. Snyder
- Department of Dermatology University of Utah Salt Lake City Utah USA
- Department of Population Health Sciences University of Utah Salt Lake City Utah USA
- Huntsman Cancer Institute Salt Lake City Utah USA
| | - Scott R. Florell
- Department of Dermatology University of Utah Salt Lake City Utah USA
| | - Rodney Miles
- Department of Pathology University of Utah Salt Lake City Utah USA
- Huntsman Cancer Institute Salt Lake City Utah USA
| | - Deborah Stephens
- Huntsman Cancer Institute Salt Lake City Utah USA
- Department of Hematology and Hematologic Malignancies University of Utah Salt Lake City Utah USA
| | - David A. Wada
- Department of Dermatology University of Utah Salt Lake City Utah USA
- Huntsman Cancer Institute Salt Lake City Utah USA
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7
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Šajn M, Luzar B, Zver S. Wells’ syndrome possibly caused by hematologic malignancy, influenza vaccination or ibrutinib: A case report. World J Clin Cases 2022; 10:10997-11003. [PMID: 36338211 PMCID: PMC9631159 DOI: 10.12998/wjcc.v10.i30.10997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/11/2022] [Accepted: 09/06/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Wells’ syndrome (eosinophilic cellulitis) is an uncommon eosinophilic dermatosis of uncertain pathogenesis, characterized by clinical polymorphism and suggestive but nonspecific histopathologic traits. Its course is recurrent, and response to therapy is unpredictable. In a case in which the patient has a number of potential triggers for the manifestation of Wells’ syndrome skin rash, the treating physician must decide or must make an assumption in order to establish the most likely clinical scenario. This is important for the patient’s future treatment plans.
CASE SUMMARY We describe the clinical case of a 46-year-old female with chronic lymphocytic leukemia who had already received treatment for several months with ibrutinib. She was diagnosed with Wells’ syndrome 10 d after an influenza vaccination containing thimerosal. Based on the literature, the patient was treated with a course of oral steroids. Resolution of clinical symptoms and rash were observed in response to the treatment. Ibrutinib was not discontinued.
CONCLUSION The etiology of Wells’ syndrome remains unknown. Clinically, it resembles bacterial cellulitis. Lack of response to antibiotic treatment should lead the physician to consider a diagnosis of Wells’ syndrome. Treating the underlying condition is important and may lead to resolution of the syndrome. However, the most common and effective treatment to limit the course of the disease are systemic steroids.
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Affiliation(s)
- Mihela Šajn
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Boštjan Luzar
- Institute of Pathology, Medical Faculty Ljubljana, Ljubljana 1000, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Samo Zver
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana 1000, Slovenia
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8
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Mori T, Irie K, Yamamoto T. Insect bite-like reaction in a patient with T-cell lymphoma. An Bras Dermatol 2022; 97:829-832. [PMID: 36089547 PMCID: PMC9582885 DOI: 10.1016/j.abd.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tatsuhiko Mori
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan.
| | - Kinuko Irie
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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9
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Ho TC, Compton L, Sheinbein D, Custer PL. Eosinophilic Dermatosis of Malignancy Involving the Eyelid. Ophthalmic Plast Reconstr Surg 2021; 37:e196-e198. [PMID: 34269770 DOI: 10.1097/iop.0000000000002004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 72-year-old man with history of chronic lymphocytic lymphoma presented with a tender, ulcerated cutaneous eyelid lesion. Excisional biopsy revealed a diagnosis of eosinophilic dermatosis of malignancy. This rare paraneoplastic eruption is associated with hematologic malignancies and characterized histopathologically by lymphocytic infiltration accompanied by numerous eosinophils. To our knowledge, eosinophilic dermatosis of malignancy involving the eyelid has not been previously reported.
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Affiliation(s)
- Tiffany C Ho
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences
| | - Leigh Compton
- Department of Pathology and Immunology
- Division of Dermatology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - David Sheinbein
- Division of Dermatology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Philip L Custer
- John F. Hardesty MD, Department of Ophthalmology and Visual Sciences
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10
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Sibaud V, Brun A, Meyer N, Oberic L, Lamant L, Ysebaert L. Efficacy of dupilumab in eosinophilic dermatosis of haematologic malignancy (EDHM) needs to be confirmed. J Eur Acad Dermatol Venereol 2021; 36:e213-e215. [PMID: 34657337 DOI: 10.1111/jdv.17748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- V Sibaud
- Oncodermatology Department, Institut Claudius Regaud and Institut, Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - A Brun
- Oncodermatology Department, Institut Claudius Regaud and Institut, Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - N Meyer
- Oncodermatology Department, Institut Claudius Regaud and Institut, Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - L Oberic
- Haematology Department, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - L Lamant
- Pathology Department, Institut Claudius Regaud and Institut, Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - L Ysebaert
- Haematology Department, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
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11
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Rozas-Muñoz E, Mir-Bonafé JF, Mozos A, Planas-Ciudad S, García-Muret MP. A 70-Year Old Man With Raspberry-Like Tumors on the Nipples: Answer. Am J Dermatopathol 2021; 42:708-709. [PMID: 32833738 DOI: 10.1097/dad.0000000000001531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eduardo Rozas-Muñoz
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain; and
| | - Juan F Mir-Bonafé
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain; and
| | - Ana Mozos
- Derpartment of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sergi Planas-Ciudad
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain; and
| | - Maria P García-Muret
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain; and
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12
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Robustelli Test E, Moggio E, Sena P, Gambini DM. A blinking knee: Quincke's sign as a reaction to insect bite in a chronic lymphocytic leukaemia patient. J Eur Acad Dermatol Venereol 2021; 35:e761-e762. [PMID: 34057763 DOI: 10.1111/jdv.17426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/07/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - E Moggio
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - P Sena
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - D M Gambini
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
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13
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Wimalachandra M, Basu TN, Salisbury J, Attard N, Calonje E, Patten PEM. Chronic lymphocytic leukaemia-associated insect bite-like reaction responding to ibrutinib, an immunomodulatory Bruton tyrosine kinase inhibitor. Clin Exp Dermatol 2021; 46:1569-1571. [PMID: 34028865 DOI: 10.1111/ced.14761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M Wimalachandra
- Department of, Haematological Medicine, King's College Hospital, London, UK
| | - T N Basu
- Department of, Dermatology, King's College Hospital, London, UK
| | - J Salisbury
- Department of, Histopathology, King's College Hospital, London, UK
| | - N Attard
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - E Calonje
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - P E M Patten
- Department of, Haematological Medicine, King's College Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College Hospital, London, UK
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14
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Fried LJ, Criscito MC, Stevenson ML, Pomeranz MK. Chronic lymphocytic leukemia and the skin: implications for the dermatologist. Int J Dermatol 2021; 61:519-531. [PMID: 33951189 DOI: 10.1111/ijd.15629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/09/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022]
Abstract
B-cell chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the United States, and its diagnosis can have many dermatologic implications. For one, the cutaneous manifestations of CLL include several entities, most notably leukemia cutis, eosinophilic dermatosis of hematologic malignancy, and a heightened risk of skin infections. Additionally, CLL patients are at an increased risk of secondary malignancies, most commonly of the skin. Furthermore, a number of commonly utilized treatments for CLL have cutaneous implications which should be considered in the interdisciplinary management of CLL patients. In this review, we will provide an update on the diverse cutaneous manifestations of CLL and CLL-directed therapies in order to help guide dermatologic management of this increasingly prevalent patient population.
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Affiliation(s)
- Lauren J Fried
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, NY, USA
| | - Maressa C Criscito
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, NY, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, NY, USA
| | - Miriam K Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York City, NY, USA
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Abstract
Haematological malignancies induce important alterations of the immune system, which account for the high frequency of autoimmune complications observed in patients. Cutaneous immune-mediated diseases associated with haematological malignancies encompass a heterogeneous group of dermatoses, including, among others, neutrophilic and eosinophilic dermatoses, autoantibody-mediated skin diseases, vasculitis and granulomatous dermatoses. Some of these diseases, such as paraneoplastic pemphigus, are associated with an increased risk of death; others, such as eosinophilic dermatoses of haematological malignancies, run a benign clinical course but portend a significant negative impairment on a patient’s quality of life. In rare cases, the skin eruption reflects immunological alterations associated with an unfavourable prognosis of the associated haematological disorder. Therapeutic management of immune-mediated skin diseases in patients with haematological malignancies is often challenging. Systemic corticosteroids and immunosuppressive drugs are considered frontline therapies but may considerably augment the risk of serious infections. Indeed, developing a specific targeted therapeutic approach is of crucial importance for this particularly fragile patient population. This review provides an up-to-date overview on the immune-mediated skin diseases most frequently encountered by patients with onco-haematological disorders, discussing new pathogenic advances and therapeutic options on the horizon.
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16
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Lor M, Gates G, Yu Y. Eosinophilic dermatosis of hematologic malignancy effectively controlled with omalizumab maintenance therapy. Dermatol Ther 2020; 33:e14206. [PMID: 32816408 DOI: 10.1111/dth.14206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022]
Abstract
Treatment of eosinophilic dermatosis of hematologic malignancy (EDHM) has been challenging with a minimal response to several modalities. Only systemic corticosteroids have consistently proven successful in suppressing the rash; however, the response is often only partial, and symptoms tend to recur as the dosage is tapered. This demonstrates the need for effective maintenance therapy. Herein, we present a case of EDHM that, following a 1 month prednisone taper and brief trial of narrow-band ultraviolet B phototherapy, has remained well-controlled with omalizumab. This suggests that omalizumab may represent an effective therapeutic alternative in EDHM management with low long-term toxicity.
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Affiliation(s)
- Michael Lor
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Gregory Gates
- Division of Dermatopathology, Department of Pathology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Yang Yu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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17
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Successful use of venetoclax for treatment of eosinophilic dermatosis of myeloproliferative disease in a patient with chronic lymphocytic leukemia. Ann Hematol 2020; 99:1129-1131. [PMID: 32193627 DOI: 10.1007/s00277-020-03991-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
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18
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Jin A, Pousti BT, Savage KT, Mollanazar NK, Lee JB, Hsu S. Eosinophilic dermatosis of hematologic malignancy responding to dupilumab in a patient with chronic lymphocytic leukemia. JAAD Case Rep 2019; 5:815-817. [PMID: 31508473 PMCID: PMC6726863 DOI: 10.1016/j.jdcr.2019.07.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Annie Jin
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- Correspondence to: Annie Jin, BA, Department of Dermatology, Lewis Katz School of Medicine at Temple University, 1316 W Ontario St, 1st Floor, Philadelphia, PA 19140.
| | - Bobak T. Pousti
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Kevin T. Savage
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Nicholas K. Mollanazar
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason B. Lee
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Jefferson University, Philadelphia, Pennsylvania
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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19
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Grandi V, Maglie R, Antiga E, Vannucchi M, Delfino C, Lastrucci I, Gunnella S, Ciolli S, Quintarelli L, Massi D, Caproni M, Pimpinelli N. Eosinophilic dermatosis of hematologic malignancy: A retrospective cohort of 37 patients from an Italian center. J Am Acad Dermatol 2019; 81:246-249. [DOI: 10.1016/j.jaad.2018.11.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 02/08/2023]
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20
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Zhai LL, Savage KT, Qiu CC, Jin A, Valdes-Rodriguez R, Mollanazar NK. Chronic Pruritus Responding to Dupilumab-A Case Series. MEDICINES 2019; 6:medicines6030072. [PMID: 31261951 PMCID: PMC6789555 DOI: 10.3390/medicines6030072] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/15/2019] [Accepted: 06/26/2019] [Indexed: 11/21/2022]
Abstract
Background: Chronic pruritus is defined as itch lasting for greater than six weeks. Pruritus is a burdensome manifestation of several internal and external disease states with a significant impact on quality of life. Dupilumab has shown promise in treating a number of conditions including atopic dermatitis (AD) and asthma. Its success in reducing pruritus in AD has generated interest regarding its potential application in other pruritic conditions, such as chronic pruritus of unknown origin, uremic pruritus, and pruigo nodularis. Methods: In this retrospective analysis, we present a series of 20 recalcitrant pruritus patients seen at a tertiary center treated with off-label dupilumab at standard AD dosing. Results: Dupilumab was successful at reducing itch in all treated patients, leading to complete resolution in 12/20 patients and an overall mean NRSi reduction of 7.55. Dupilumab was well tolerated with no significant adverse effects. Conclusions: Our case series suggests dupilumab may be a safe and efficacious therapeutic option in several pruritic conditions and demonstrates the need for further studies to better ascertain its place in the pruritus treatment armamentarium.
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Affiliation(s)
- Lisa L Zhai
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Kevin T Savage
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Connie C Qiu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA.
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA.
| | - Annie Jin
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | | | - Nicholas K Mollanazar
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19140, USA
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21
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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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22
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Maglie R, Grandi V, Massi D, Caproni M, Pimpinelli N, Antiga E. Cutaneous eruptions associated with haematologic malignancies: the need for a unifying nomenclature. J Eur Acad Dermatol Venereol 2019; 33:e191-e192. [DOI: 10.1111/jdv.15452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- R. Maglie
- Division of Dermatology Department of Surgery and Translational Medicine University of Florence Florence Italy
| | - V. Grandi
- Division of Dermatology Department of Surgery and Translational Medicine University of Florence Florence Italy
| | - D. Massi
- Division of Pathological Anatomy Department of Surgery and Translational Medicine University of Florence Florence Italy
| | - M. Caproni
- Division of Dermatology Department of Surgery and Translational Medicine University of Florence Florence Italy
| | - N. Pimpinelli
- Division of Dermatology Department of Surgery and Translational Medicine University of Florence Florence Italy
| | - E. Antiga
- Division of Dermatology Department of Surgery and Translational Medicine University of Florence Florence Italy
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23
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Meiss F, Technau-Hafsi K, Kern JS, May AM. Eosinophilic dermatosis of hematologic malignancy: Correlation of molecular characteristics of skin lesions and extracutaneous manifestations of hematologic malignancy. J Cutan Pathol 2018; 46:175-181. [PMID: 30411384 DOI: 10.1111/cup.13389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/27/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin diseases are frequent in patients with chronic lymphocytic leukemia (CLL) and other hematological neoplasias. Eosinophilic dermatosis (ED) of hematologic malignancy has long been considered a nonspecific cutaneous reaction pattern. Recently neoplastic cells have been shown to be present in ED, thus challenging the classification as a nonspecific dermatosis. METHODS We report five patients with ED in association with CLL. We further investigated the presence of neoplastic B-cells in the skin infiltrate by immunohistochemistry and immunoglobulin heavy chain rearrangement and compared these to extracutaneous manifestations of CLL. RESULTS The phenotype of the lymphocytic infiltrate was predominately CD3+ (range: 60%-90%). CD20+ and CD79a+ lymphocytes were less frequent, accounting for up to 15% (range: absent - 15%). CD23+ lymphocytes represented up to 20% (range: absent - 20%) of the infiltrate. The analysis of the immunoglobulin heavy chain rearrangement in the skin specimens showed clonal rearrangements in 4/5 patients and in three of these four patients clones were identical to extracutaneous CLL manifestations. CONCLUSION Our data show that neoplastic B-cells are very frequently found in ED when systematically evaluated. This findings support the hypothesis that leukemic cells play a pathogenetic role in ED of hematologic malignancy.
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Affiliation(s)
- Frank Meiss
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kristin Technau-Hafsi
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes S Kern
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Departments of Dermatology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville and Box Hill Hospital - Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Annette M May
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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24
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Maglie R, Quintarelli L, Caproni M, Antiga E. Is chemotherapy the best option for chronic lymphocytic leukemia associated Wells' syndrome? Reply to "Case of Wells' syndrome: A rare association with the clinical course of chronic lymphocytic leukemia". J Dermatol 2018; 46:e146-e147. [PMID: 30362593 DOI: 10.1111/1346-8138.14668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Roberto Maglie
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Marzia Caproni
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Emiliano Antiga
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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25
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Kim JE, Kim SC. Insect Bite-Like Reaction with Bullous Lesions Mimicking Bullous Pemphigoid in a Patient with Chronic Lymphocytic Leukemia. Ann Dermatol 2018; 30:468-472. [PMID: 30065590 PMCID: PMC6029966 DOI: 10.5021/ad.2018.30.4.468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Jee Eun Kim
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Chan Kim
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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26
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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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27
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Roberto M, Emiliano A, Marzia C. Comment on “Association of bullous pemphigoid with malignancy: A systematic review and meta-analysis”. J Am Acad Dermatol 2018; 85:e343. [DOI: 10.1016/j.jaad.2017.10.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 11/15/2022]
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28
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Tadmor T, Welslau M, Hus I. A review of the infection pathogenesis and prophylaxis recommendations in patients with chronic lymphocytic leukemia. Expert Rev Hematol 2017; 11:57-70. [DOI: 10.1080/17474086.2018.1407645] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tamar Tadmor
- The Ruth and Bruce Rappaport Faculty of Medicine, Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Manfred Welslau
- Haemato-Onkologische Schwerpunktpraxis am Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Iwona Hus
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
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29
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Maglie R, Antiga E, Vannucchi M, Del Bianco E, Bianchi B, Massi D, Caproni M. Bullous eruption in a patient with B-cell chronic lymphocytic leukemia: a diagnostic challenge. Int J Dermatol 2017; 56:1445-1447. [PMID: 29076242 DOI: 10.1111/ijd.13807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/28/2017] [Accepted: 09/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Roberto Maglie
- Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence, Florence, Italy
| | - Emiliano Antiga
- Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence, Florence, Italy
| | - Margherita Vannucchi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence Italy
| | - Elena Del Bianco
- Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence, Florence, Italy
| | - Beatrice Bianchi
- Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence, Florence, Italy
| | - Daniela Massi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence Italy
| | - Marzia Caproni
- Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence, Florence, Italy
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30
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Insect bite-like reaction in a patient with chronic lymphocytic leukemia. DERMATOL SIN 2017. [DOI: 10.1016/j.dsi.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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31
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Bari O, Cohen PR. Eosinophilic dermatosis of hematologic malignancy mimicking varicella zoster infection: report in a woman with chronic lymphocytic leukemia and review of the literature. Dermatol Pract Concept 2017; 7:6-15. [PMID: 29085714 PMCID: PMC5661154 DOI: 10.5826/dpc.0703a02] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/29/2017] [Indexed: 10/31/2022] Open
Abstract
Eosinophilic dermatosis of hematologic malignancy is a rare papulovesicular eruption that presents in patients with hematoproliferative disorders, particularly chronic lymphocytic leukemia. A 59-year-old woman with chronic lymphocytic leukemia who developed eosinophilic dermatosis of hematologic malignancy mimicking varicella zoster infection is described. PubMed database was searched with the key words: chronic, dermatosis, eosinophilic, hematologic, infection, leukemia, lymphocytic, malignancy, varicella, zoster. The papers generated by the search and their references were reviewed. The patient presented, on more than 20 occasions, with a dermatomal vesicular eruption. Her oncologist, based on the clinical presentation, treated each episode as recurrent varicella zoster virus infection. A complete workup of the patient not only demonstrated negative viral studies but also revealed pathologic changes consistent with eosinophilic dermatosis of hematologic malignancy on lesional skin biopsy. The recurrence of the patient's dermatosis was less frequent when her malignancy was under better control. Eosinophilic dermatosis of hematologic malignancy may mimic other reactive dermatoses. The morphology of our patient's recurrent dermatosis resembled varicella zoster virus infection. Disseminated zoster virus infection with dermatomal and non-dermatomal distribution should be added to the clinical differential diagnosis of eosinophilic dermatosis of hematologic malignancy.
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Affiliation(s)
- Omar Bari
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, CA, USA
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32
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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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33
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Wendtner CM, Polliack A. Basophils go wild when mosquitoes bite CLL. Leuk Lymphoma 2016; 57:2243-4. [PMID: 27181581 DOI: 10.1080/10428194.2016.1180691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Clemens-Martin Wendtner
- a Department of Internal Medicine, Klinikum Schwabing , Academic Teaching Hospital of University of Munich , Munich , Germany
| | - Aaron Polliack
- b Department of Hematology, Hadassah University Hospital and Hebrew University Medical School , Jerusalem , Israel
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34
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Tatsuno K, Fujiyama T, Matsuoka H, Shimauchi T, Ito T, Tokura Y. Clinical categories of exaggerated skin reactions to mosquito bites and their pathophysiology. J Dermatol Sci 2016; 82:145-52. [PMID: 27177994 DOI: 10.1016/j.jdermsci.2016.04.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 01/01/2023]
Abstract
Mosquito bites are skin irritating reactions, which usually resolve spontaneously without intensive medical care. However, in certain situations, mosquito bites may form a more vicious reaction, sometimes accompanying fever and systemic symptoms. In such cases, the presence of rare hematological disorders, abnormalities in eosinophils and/or association with Epstein-Barr virus (EBV) may underlie. Importantly, hypersensitivity to mosquito bites (HMB), which is characterized by necrotic skin reactions to mosquito bites with various systemic symptoms, is often observed in association with EBV infection and natural killer (NK) cell lymphoproliferative disorder. Exaggerated skin reaction to mosquito bites is also seen in Wells' syndrome. While strong Th2-skewing immune dysregulation is apparent in the patients, they also show robust CD4(+) T cell proliferation in response to mosquito salivary gland extracts, indicating close association between Wells' syndrome and mosquito bites. Similar skin reaction to mosquito bites is also noticed in certain types of B cell neoplasm, although the role of B cells in this peculiar reaction to mosquito bites is yet to be elucidated. In this review, we will discuss the current knowledge of exaggerated reaction toward mosquito bites seen in conjunction with these unique hematological disorders, and examine the scientific studies and observations reported in previous literatures to organize our current understanding of the pathogenesis of this distinct disorder.
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Affiliation(s)
- Kazuki Tatsuno
- Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1Handayama, Higashi-ku, Hamamatsu 431-3192, Japan.
| | - Toshiharu Fujiyama
- Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
| | - Hiroyuki Matsuoka
- Division of Medical Zoology, Jichi Medical University, 3311-1 Yakusiji, Shimotsuke-shi, Tochigi-ken 329-0498, Japan
| | - Takatoshi Shimauchi
- Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
| | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
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35
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Mongini PKA, Gupta R, Boyle E, Nieto J, Lee H, Stein J, Bandovic J, Stankovic T, Barrientos J, Kolitz JE, Allen SL, Rai K, Chu CC, Chiorazzi N. TLR-9 and IL-15 Synergy Promotes the In Vitro Clonal Expansion of Chronic Lymphocytic Leukemia B Cells. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2015; 195:901-23. [PMID: 26136429 PMCID: PMC4505957 DOI: 10.4049/jimmunol.1403189] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/30/2015] [Indexed: 12/20/2022]
Abstract
Clinical progression of B cell chronic lymphocytic leukemia (B-CLL) reflects the clone's Ag receptor (BCR) and involves stroma-dependent B-CLL growth within lymphoid tissue. Uniformly elevated expression of TLR-9, occasional MYD88 mutations, and BCR specificity for DNA or Ags physically linked to DNA together suggest that TLR-9 signaling is important in driving B-CLL growth in patients. Nevertheless, reports of apoptosis after B-CLL exposure to CpG oligodeoxynucleotide (ODN) raised questions about a central role for TLR-9. Because normal memory B cells proliferate vigorously to ODN+IL-15, a cytokine found in stromal cells of bone marrow, lymph nodes, and spleen, we examined whether this was true for B-CLL cells. Through a CFSE-based assay for quantitatively monitoring in vitro clonal proliferation/survival, we show that IL-15 precludes TLR-9-induced apoptosis and permits significant B-CLL clonal expansion regardless of the clone's BCR mutation status. A robust response to ODN+IL-15 was positively linked to presence of chromosomal anomalies (trisomy-12 or ataxia telangiectasia mutated anomaly + del13q14) and negatively linked to a very high proportion of CD38(+) cells within the blood-derived B-CLL population. Furthermore, a clone's intrinsic potential for in vitro growth correlated directly with doubling time in blood, in the case of B-CLL with Ig H chain V region-unmutated BCR and <30% CD38(+) cells in blood. Finally, in vitro high-proliferator status was statistically linked to diminished patient survival. These findings, together with immunohistochemical evidence of apoptotic cells and IL-15-producing cells proximal to B-CLL pseudofollicles in patient spleens, suggest that collaborative ODN and IL-15 signaling may promote in vivo B-CLL growth.
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MESH Headings
- ADP-ribosyl Cyclase 1/metabolism
- Aged
- Aged, 80 and over
- Apoptosis/immunology
- Ataxia Telangiectasia Mutated Proteins/genetics
- B-Lymphocytes/immunology
- Cell Proliferation/genetics
- Cells, Cultured
- Chromosome Aberrations
- Female
- Humans
- Immunoglobulin Heavy Chains/genetics
- Interleukin-15/immunology
- Interleukin-15/pharmacology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Membrane Glycoproteins/metabolism
- Middle Aged
- Myeloid Differentiation Factor 88/genetics
- Oligodeoxyribonucleotides/pharmacology
- Receptors, Antigen, B-Cell/immunology
- Signal Transduction/immunology
- Toll-Like Receptor 9/immunology
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Affiliation(s)
- Patricia K A Mongini
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11549;
| | - Rashmi Gupta
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Erin Boyle
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Jennifer Nieto
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Hyunjoo Lee
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Joanna Stein
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030
| | - Jela Bandovic
- Department of Pathology, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY 11030
| | - Tatjana Stankovic
- School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Jacqueline Barrientos
- Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and
| | - Jonathan E Kolitz
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Steven L Allen
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Kanti Rai
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
| | - Charles C Chu
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11549
| | - Nicholas Chiorazzi
- The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030; Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11549; Department of Medicine, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY; and Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
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36
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Hibler J, Salavaggione AL, Martin A, Gru AA. A unique case of concurrent chronic lymphocytic leukemia/small lymphocytic lymphoma and lymphomatoid papulosis in the same biopsy. J Cutan Pathol 2014; 42:276-84. [PMID: 25382820 DOI: 10.1111/cup.12435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 11/26/2022]
Abstract
Chronic lymphocytic leukemia (CLL/SLL) is the most common leukemia in the western world and its cutaneous dissemination a very uncommon phenomenon. Lymphomatoid papulosis (LyP) is a CD30+ lymphoproliferative disorder characterized by chronic, recurrent and self healing skin lesions. Up to 20% of patients with LyP have a coexistent lymphoma. While the association between the two entities has been reported, their coexistence has never been documented. We describe a 74-year-old man with known CLL and thrombocytopenia who presented with a 2 year history of recurrent nodules and plaques to both arms and legs that resolved within 4-6 weeks after administration of rituximab and bendamustin for his CLL treatment. His biopsies showed an atypical lymphoid infiltrate, composed of large and pleomorphic cells with a nodular and interstitial pattern in a background of eosinophils. Immunohistochemical staining revealed a pattern of two separate yet coexisting neoplastic processes; a large CD30 positive T-cell lymphoproliferative disorder, while the other one was diagnostic of a neoplastic B-cell process (leukemia cutis). A diagnosis of coexistent LyP and cutaneous involvement by CLL/SLL was rendered. The simultaneous presence of both disorders can be a pitfall in the differential diagnosis of large cell lymphomas, such as Richter's transformation of CLL/SLL.
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Affiliation(s)
- J Hibler
- O'Bleness Hospital, Ohio University, Athens, OH, USA
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37
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Butzmann CM, Kern JS, Stanislawski G, Meiss F. Insect bite-like reaction in a patient with chronic lymphocytic leukemia. J Dtsch Dermatol Ges 2014; 12:734-7. [DOI: 10.1111/ddg.12326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Johannes S. Kern
- Department of Dermatology Medical Center - University of Freiburg
| | | | - Frank Meiss
- Department of Dermatology Medical Center - University of Freiburg
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38
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Lorente-Lavirgen AI, López-López R, Baquero-Sánchez E, Pulpillo-Ruiz A, De Zulueta-Dorado T, Conejo-Mir J. Pruritic nodules and plaques on the arms with blisters in a patient with chronic lymphocytic leukemia. Int J Dermatol 2014; 53:277-9. [DOI: 10.1111/ijd.12257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rocío López-López
- Department of Dermatology; Virgen del Rocío University Hospital; Seville Spain
| | - Elena Baquero-Sánchez
- Department of Dermatology; Virgen del Rocío University Hospital; Seville Spain
- Department of Pathology; Virgen del Rocío University Hospital; Seville Spain
| | | | | | - Julian Conejo-Mir
- Department of Dermatology; Virgen del Rocío University Hospital; Seville Spain
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