Discussion
Based on clinical, biological, and histological findings, a diagnosis of SS was established [1]; however, we found an inflammatory infiltrate rich in PNE. Indeed, the presence of some PNEs in association with neutrophilic infiltrates during SS has been well documented in the literature [2]. In a study of 73 cases of SS, the presence of PNE in association with neutrophilic infiltration was reported in 41% of cases [2]. However, eosinophil-rich SS is an exception. To the best of our knowledge, only three cases of eosinophils-rich SS have been reported [3, 4]. Among these three observations, one case was described in association with digestive T-cell lymphoma [4]. The clinical and histological features of the patients are summarized in Table 1.
In our case, the insect bite triggered a cutaneous eruption. So, the diagnosis of ”exaggerated reactions to insect bites” also called ”Eosinophilic Dermatoses of Hematologic Malignancies” (EDHM) can be evoked [5].
The present dermatosis seems to be an immunological reaction caused by sensitization to proteins in insect saliva [5]. It is characterized by one or multiple erythematous lesions, 2-10 cm in size, which appear a few hours after the insect bite with progressive extension and spontaneous healing after 3 to 10 days, without a febrile context [5]. Histologically, EDHM is characterized by the presence of numerous PNEs within the dermal infiltrate [5]. We suggest an overlap between paraneoplastic eosinophil-rich SS and EDHM. Therefore, we believe, that EDHM can be considered an eosinophil-rich SS.
Conclusion: We report an extremely rare case of SS characterized by rich dermal infiltration of eosinophils in association with CLL. Through our case report and the literature, we highlight the relationship between EDHM and paraneoplastic eosinophil-rich SS to make the clinician and the anatomopathologist aware of this new entity.