报告以蚊虫叮咬超敏反应为首发皮肤表现的小淋巴细胞淋巴瘤1例.患者男,49岁,因头颈部蚊虫叮咬后红肿伴瘙痒反复5年,再发1周就诊.皮肤科检查:右颊外侧、颈后部偏右侧、右肩胛下区域红斑、肿胀,局部见粟粒至绿豆大小丘疱疹、水疱,少许渗液,右颈部大片红肿.右耳后、右下颌、双侧颈部、双腋下淋巴结肿大,右颈部淋巴结肿大显著,轻触痛.右颈部淋巴结组织病理提示淋巴结正常结构破坏,见大量小淋巴细胞增生,细胞形态较为一致,胞浆少,核仁不明显,核分裂像少见.免疫组化:CD20(+),Pax-5(+),CD3(-),CD5(+),CD23(+),Bcl-2(+),Bcl-6(-),CD10(-),Cyclin-D1(-),SOX-11(-),Mum-1(-),CD4(-),CD8(-),CD56(-),Ki-67(约 30％+).原位杂交:EBER(-).EB 病毒 DNA 定量:1.08 ×104/L.EB 病毒抗体:EB-VCA-IgG＞750.0 U/mL.诊断:①慢性淋巴细胞白血病/小淋巴细胞淋巴瘤;②蚊虫叮咬超敏反应.予甲泼尼龙、头孢呋辛治疗后,皮肤红肿及瘙痒症状减轻.患者转入血液科,因暂无治疗指征,目前随访中.
A case of small lymphocytic lymphoma with hypersensitive reactions to mosquito bites as the first skin manifestation
We report a case of small lymphocytic lymphoma with hypersensitive reactions to mosquito bites as the first skin manifestation.A 49-year-old male presented with a 5-year history of repeated swollen and itching on the head and neck region after mosquito bites.The current episode occurred a week ago.The findings of dermatological examination included swollen erythemas cov-ered with millet-to green bean-sized papules and vesicles accompanied with exudation on the right lateral cheek,the right part of posterior neck and right subscapular region.There were lymphade-nopathies behind the right ear,in the lower right jaw,the bilateral neck and armpits,with tender-ness.The histopathology of right cervical lymph node showed destruction of lymph nodes and a large number of small lymphocytes,with uniform morphology,less cytoplasm,inconspicuous nu-cleoli,and few mitotic figures.Immunohistochemistry showed CD20(+),Pax-5(+),CD3(-),CD5(+),CD23(+),Bcl-2(+),Bcl-6(-),CD10(-),Cyclin-D1(-),SOX-11(-),Mum-1(-),CD4(-),CD8(-),CD56(-),Ki-67(30％+).In situ hybridization showed EBER negative.Anti-EBV antibody(EB-VCA-IgG)levels were＞750.0 U/mL.The di-agnoses of chronic lymphocytic leukemia/small lymphocytic lymphoma and hypersensitivity to mos-quito bites were made.The patient was transferred to the hematology department and is currently under follow-up because of no indication for treatment.
small lymphocytic lymphomahypersensitivity to mosquito bitesEB viruslymphadenectasis
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