EXAGGERATED ARTHROPOD-BITE LESIONS IN PATIENTS WITH CHRONIC LYMPHOCYTIC-LEUKEMIA - A CLINICAL, HISTOPATHOLOGIC, AND IMMUNOPATHOLOGIC STUDY OF 8 PATIENTS

Background: Unusual papulovesicular lesions resembling arthropod bites have been described in patients with chronic lymphocytic leukemia (CL L). Objective: Our purpose was to describe and characterize further th e clinical, histopathologic, and immunopathologic features of these le sions. Methods: Eight patients were identified retrospectively who had CLL and characteristic skin lesions. Clinical and histologic features were recorded. Skin biopsy specimens were analyzed immunohistochemica lly for eosinophil granule major basic protein, eosinophil-derived neu rotoxin, neutrophil elastase, and mast cell tryptase. Results: The cli nical features, including the lesional distribution, suggested arthrop od bites, although most patients could not recall having been bitten. Mixed T- and B-cell lymphoid cell infiltrates were present within lesi ons, along with prominent eosinophil infiltration and eosinophil granu le protein deposition. Conclusion: Exuberant papulovesicular lesions d evelop in patients with CLL apparently as an exaggerated response to a rthropod bites. Prominent eosinophil infiltration and degranulation wi thin these lesions likely contribute to the severity of symptoms.