Case report
A 65-year-old woman, diagnosed a CLL stage A of Binet, was stable for 5 years and has not require any specific treatment. She presented with febrile multiple erythematous and painful cutaneous lesions, three days prior to presentation. These lesions initially appeared on the buttocks, a few hours after an insect bite, with progressive extension to the skin sites. The patient had not received any new medications prior to the rash. Dermatological examination revealed multiple purplish erythematous plaques with different sizes varying from 1 to 3 cm, infiltrated borders, and centrifugal extension on the trunk, limbs, neck, and face (Fig. 1A and B). The palms of the hands were also affected (Fig. 1C). We did not observe any modifications in the surrounding area. The rest of the physical examinations revealed no abnormalities. Biological examinations were within normal levels despite the biological inflammatory syndrome. Histological examination of the cutaneous biopsy specimen revealed oedematous dermis associated with abundant perivascular and interstitial inflammatory infiltrates (Fig. 2A). This infiltrate was mainly composed of neutrophils associated with numerous polynuclear eosinophilic cells (PNEs) (Fig. 2B). She was treated with oral doxycycline at 100 mg/j in association with high-level topical corticosteroids (one application per day) for 10 days, resulting in clinical improvement and apyrexia from the 3rd day of treatment. The assessment of her haematological malignancy revealed a stable condition at stage A of Binet.