Hypersensitivity to mosquito bites (HMB) is characterized by intense skin reactions at bite sites, which consist of erythema/bulla and ulcer/scar and is associated with general symptoms such as high fever, general malaise, cramps and renal failure.
Clinical features
Cutaneous manifestations:
Intense local skin symptoms: Erythema, bullae, ulcers, and scarring.
Skin lesions showed pustules, ulcerations, eschars and edematous change on the face and the right ear. | Chung, J. S., Shin, H. J., Lee, E. Y., & Cho, G. J. (2003). Hypersensitivity to mosquito bites associated with natural killer cell-derived large granular lymphocyte lymphocytosis: a case report in Korea. The Korean Journal of Internal Medicine, 18(1), 50–52. https://doi.org/10.3904/kjim.2003.18.1.50
Systemic manifestations:
Fever, lymphadenopathy, and liver dysfunction
Diagnosis
Investigations
Peripheral blood smear:
Large granular lymphocyte in peripheral blood (Wright stain, ×1000). | Chung, J. S., Shin, H. J., Lee, E. Y., & Cho, G. J. (2003). Hypersensitivity to mosquito bites associated with natural killer cell-derived large granular lymphocyte lymphocytosis: a case report in Korea. The Korean Journal of Internal Medicine, 18(1), 50–52. https://doi.org/10.3904/kjim.2003.18.1.50
PCR analysis:
PCR analysis of T-cell receptor (TCR)-chain gene. Lane 1, markers; lane 2, positive control; lane 3, negative control; lane 4, case. | Stone, M. J., & Bogen, S. A. (2012). Evidence-based focused review of management of hyperviscosity syndrome. Blood, 119(10), 2205 LP-2208. Retrieved from http://www.bloodjournal.org/content/119/10/2205.abstract
Histopathology
Epidermis: Necrosis & ulceration
Dermis:
Oedema & infiltration of polymorphonuclear leukocytes, nuclear debris, and extravasated erythrocyteswith fibrinoid necrosis of small vessels.
Infiltrating small lymphocytes extend from the dermis to the subcutis in anangiocentric pattern
