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.