J Korean Med Sci.  2013 Jan;28(1):164-166. 10.3346/jkms.2013.28.1.164.

A Case of Hypersensitivity to Mosquito Bites without Peripheral Natural Killer Cell Lymphocytosis in a 6-Year-Old Korean Boy

• Seon HS
• Roh JH
• Lee SH
• Kang EK

• KMID: 2158018
• DOI: http://doi.org/10.3346/jkms.2013.28.1.164

Abstract

Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by intense skin reactions such as bulla and necrotic ulcerations at bite sites, accompanied by general symptoms such as high-grade fever and malaise occurred after mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer (NK) cell leukemia/lymphoma. We describe here a Korean child who presented with 3-yr history of HMB without natural killer cell lymphocytosis. He has been ill for 6 yr with HMB. Close observation and examination for the development of lymphoproliferative status or hematologic malignant disorders is needed.

Keyword

Hypersensitivity; Mosquito Bites; Epstein-Barr Virus; Natural Killer Cell

MeSH Terms

Child
Epstein-Barr Virus Infections/complications
Humans
Hypersensitivity/*diagnosis/etiology
Insect Bites and Stings/*diagnosis/pathology
Killer Cells, Natural/immunology
Lymphocytosis/complications/pathology
Male
Republic of Korea
Skin/pathology

Figure

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  Fig. 1 Gross appearance of the skin lesion. (A) Erythematous swelling with a central bulla. (B) Another bullous skin lesion developed 1 yr after diagnosis of HMB. (C) Eschar formation from a bulla at a mosquito bite site.

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  Fig. 2 Pathologic findings of the skin lesion. (A: H&E, × 100, B: × 400). Histopathologic examination of the skin biopsy specimen showed intraepidermal vesicles with interstitial and perivascular infiltration of lymphocytes, neutrophils, eosinophils and histiocytes. (C) In situ hybridization analysis for EBER was positive (dark brown color, × 400). (D) Immunohistochemical staining with CD56 was negative (× 400).

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