Skin Lesions in a Patient with Chronic Lymphocytic Leukemia (CLL) Associated with Known or Presumed Arthropod Bites

 

Clinical features:

(1) The patient has CLL.

(2) The patient develops papules, vesicles, bullae and/or nodules.

(3) The lesions are usually on the extremities or face but may also involve the trunk.

(4) The patient may or may not recall the occurrence of insect bites at the site(s) preceding the appearance of the lesion(s).

 

Histopathologic findings:

(1) lymphocytic infiltrate composed of a mixture of T and B cells

(2) eosinphils

 

Differential diagnosis:

(1) lymphoma cutis (would be associated with a monoclonal lymphoid infiltrate)

(2) infection