Hypersensitivity to mosquito bites as the primary clinical manifestation of a juvenile type of Epstein-Barr virus-associated natural killer cell leukemia/lymphoma

Hypersensitivity to mosquito bites or mosquito allergy is a mysterious diso rder that has been reported mainly in Japanese patients (at least 58 patien ts) in the first two decades of life. The skin lesion at bite sites is typi cally a bulla that develops into necrosis. Patients simultaneously exhibit a high temperature and general malaise and subsequently may experience lymp hadenopathy and hepatosplenomegaly. Recent studies have revealed that this mosquito hypersensitivity is associated with chronic Epstein-Barr virus inf ection and natural killer cell leukemia/lymphoma. The natural killer cell, infected with monoclonal (or oligoclonal) Epstein-Barr virus, seems to be i nvolved in the pathogenesis of the hypersensitivity. Half of the patients r eported died of hemophagocytic syndrome (or malignant histiocytosis), granu lar lymphocyte proliferative disorder, or lymphomas. We propose that this d isease, defined as the triad of hypersensitivity to mosquito bites, chronic Epstein-Barr virus infection, and natural killer cell leukemia/lymphoma, i s a clinical entity mostly seen in Asians.