Eosinophilic Dermatosis of Hematologic Malignancy

Abstract

Eosinophilic dermatosis of hematologic malignancy (EDHM) is a rare chronic skin condition commonly affecting individuals with underlying hematologic malignancies, most notably chronic lymphocytic leukemia (CLL). EDHM presents as pruritic, insect-like bites, but without patient-reported contact/bites of insects. We present a case of a 44-year-old male who presented to Elkhorn Dermatology with a scaly rash and serpiginous borders on the nasal tip and right cutaneous upper lip. The patient was diagnosed with CLL one year prior and had been on zanubrutinib for 10 days since presenting to the dermatology clinic. Initial treatment with antifungal and antibiotic therapies showed no improvement, leading to a punch biopsy that revealed perivascular and periadnexal lymphocytic dermatitis with eosinophils. This finding, along with the patient's underlying CLL, led to a diagnosis of EDHM. This case highlights the diagnostic challenges and therapeutic complexities associated with EDHM in patients with hematologic malignancies.

Keywords: dermatologic manifestations; dermatological manifestation of malignancy; eosinophilic dermatosis; eosinophilic dermatosis of hematological malignancy; hematologic malignancies; medical dermatology.

Figure 1. (a) and (b) Scaly patches with a serpiginous border located on the nasal tip. (c) and (d) Erythematous papules and nodules on the bilateral cheeks and temples.

Figure 2. H&E ×1.5 and ×25 demonstrating a nodular infiltrate, composed of mature lymphocytes, histiocytes, plasma cells, and numerous eosinophils extending into the deep dermis.

H&E: hematoxylin and eosin stain.