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  

A case of small lymphocytic lymphoma with hypersensitive reactions to mosquito bites as the first skin manifestation

作　　者：韩雪 林越 钟大平 闫国富 何威 HAN Xue;LIN Yue;ZHONG Daping;YAN Guofu;HE Wei(GuiQian International General Hospital,Guiyang 550024,China)

机构地区：[1]贵黔国际总医院,贵州贵阳550024

出　　处：《皮肤性病诊疗学杂志》2024年第3期193-197,共5页Journal of Diagnosis and Therapy on Dermato-venereology

摘　　要：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:1.08×10^(4)/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。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 covered 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 lymphadenopathies behind the right ear,in the lower right jaw,the bilateral neck and armpits,with tenderness.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 nucleoli,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 diagnoses of chronic lymphocytic leukemia/small lymphocytic lymphoma and hypersensitivity to mosquito bites were made.The patient was transferred to the hematology department and is currently under follow-up because of no indication for treatment.

关 键 词：小淋巴细胞淋巴瘤 蚊虫叮咬超敏反应 EB病毒 淋巴结肿大 

分 类 号：R733.1[医药卫生—肿瘤]