Case Report Describes Treatment of Severe Mosquito Bite Allergy and EBV-Associated NK-Cell Lymphoproliferative Disorder
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Key Takeaway
Consider prednisone and methotrexate in EBV NK Lymphoproliferative disorders based on this single case report.
This publication is classified as a case report that includes a literature review of nine additional cases. The scope encompasses a 70-year-old male presenting with severe mosquito bite allergy and EBV-associated NK-cell lymphoproliferative disorders. The diagnosis was established based on clinical features, high EBV load, and histopathological findings.
The intervention involved oral prednisone and methotrexate. Primary outcomes indicated significant clinical improvement in the single patient. The disease course remained stable and indolent throughout the documented period. Absolute numbers confirm one patient experienced improvement and stability.
Follow-up duration was recorded as 2 years. Adverse events, serious adverse events, discontinuations, and tolerability were not reported in the source data. Safety profiles remain undefined for this specific regimen in this population. Reporting of safety outcomes was not available.
The authors note this represents single case report level evidence. The certainty is limited by the observational nature of the data. While the report offers insights for clinical practice, generalizability is constrained by the small sample size of one primary case. Clinicians should interpret these findings cautiously given the lack of comparative data. No statistical analysis was performed.
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View Original Abstract ↓
BackgroundSevere mosquito bite allergy (SMBA) is characterized by intense local necrotic skin reactions accompanied by systemic symptoms following mosquito bites. SMBA is currently classified within the spectrum of EBV-positive T/natural killer (NK)-cell lymphoproliferative disorders (LPDs) and is recognized as a specific cutaneous manifestation of chronic active EBV disease (CAEBVD), with a potential risk of progression to overt T/NK-cell leukemia or lymphoma.Case presentationHerein, we report a rare case of a 70-year-old male diagnosed with EBV-associated NK-cell LPD manifesting primarily as SMBA. The patient presented with recurrent disseminated erythematous plaques, bullae, necrotic ulcers, and scarring following mosquito bites, accompanied by intermittent fever. Quantitative PCR revealed a high EBV DNA load in peripheral blood, and skin biopsy demonstrated an angiocentric infiltration of EBV-positive NK cells. Based on the clinical features of SMBA, high EBV load, and histopathological findings, the diagnosis of EBV-associated NK-cell LPD was established. Treatment with oral prednisone and methotrexate resulted in significant clinical improvement, and the patient maintained a stable, indolent course during the subsequent 2-year follow-up.ConclusionWe report a rare case of elderly-onset EBV-associated NK-cell LPD manifesting as SMBA, characterized by an unusually indolent clinical course. Furthermore, we provide a comprehensive literature review of 9 previously reported adult SMBA cases to offer insights for clinical practice.
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