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Internal Medicine

Hypersensitivity to mosquito bites (HMB)

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.
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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:

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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:

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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

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