Eosinophilic dermatosis of hematologic malignancy in patients with chronic lymphocytic leukemia/non-Hodgkin's B lymphoma: a single center prospective clinico-pathological study

Andrea Michelerio; Carlo Tomasini; Giacomo Fiandrino; Mara De Amici; Marzia Varettoni; Irene Defrancesco; Chiara Cavalloni; Valeria Brazzelli; Federica Derlino; Marco Paulli; Luca Arcaini; Camilla Vassallo

doi:10.3389/fmed.2023.1231003

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 Aug 8:10:1231003. doi: 10.3389/fmed.2023.1231003. eCollection 2023.

Authors

Andrea Michelerio^{1

2}, Carlo Tomasini^{1

2}, Giacomo Fiandrino^{3

4}, Mara De Amici⁵, Marzia Varettoni^{3

6}, Irene Defrancesco^{3

6}, Chiara Cavalloni^{3

6}, Valeria Brazzelli^{1

2}, Federica Derlino^{1

2}, Marco Paulli^{3

4}, Luca Arcaini^{3

6}, Camilla Vassallo²

Affiliations

¹ Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
² Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
³ Department of Molecular Medicine, University of Pavia, Pavia, Italy.
⁴ Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
⁵ Laboratory of Immuno-Allergology of Clinical Chemistry and Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
⁶ Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

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.

Keywords: B cell chronic lymphocytic leukemia; eosinophilic dermatosis; eosinophils; insect bites; non-Hodgkin lymphoma.