An acute localized reaction following a mosquito bite in a breast cancer treated patient

Abstract

Acute localized exanthematous pustulosis (ALEP) is a rare localized variant of acute generalized exanthematous pustulosis (AGEP). We report a case of ALEP localised on the trunk and induced by a mosquito bite in a breast cancer treated female patient.

CASE PRESENTATION

A 53-year-old female patient treated for a left breast cancer with a complete mastectomy and homolateral axillary lymph node dissection, radiotherapy and chemotherapy 2 years ago, developed abruptly an indurated erythematous plaque with non-follicular pustules on the trunk (Figure 1A), with an active itchy excoriated papule on the left arm occurring 3 days after a mosquito bite (Figure 1B). There was no infectious episode, no drug intake, and no recent contact with plants prior to the clinical presentation. Histological examinal of skin biopsy showed neutrophilic spongiosis with subcorneal pustules, papillary dermal edema associated with an inflammatory infiltrate (Figure 2), and the EuroSCAR criteria was 10/12, confirming the diagnosis of acute localized exanthematous pustulosis (ALEP). The patient was treated with topical corticosteroids, achieving a complete regression of the lesions within 2 weeks.

FIGURE 1. (A) Indurated erythematous plaque with non-follicular pustules on the trunk. (B) Excoriated papule on the left arm

FIGURE 2. Neutrophilic spongiosis with subcorneal pustules, associated with dermal inflammatory infiltrate (HE X40)

DISCUSSION

Acute localized exanthematous pustulosis is a rare localized variant of acute generalized exanthematous pustulosis (AGEP). ALEP is a severe skin reaction characterized by the onset of multiple non follicular, pin-head sized, sterile pustules, developed on an erythematous and oedematous base, localized usually on the face, neck, or chest.^1,2 Our case highlights mosquito bite as a novel causative agent for ALEP in a female patient presenting skin sequelae of aggressive breast cancer treatment. The surgical and radiation treatment of breast cancer results in skin changes including postoperative lymphedema, and fibrosis. This case is remarkable in terms of the limitation of lesions to the treated area.

AUTHOR CONTRIBUTION

Randa Said El Mabrouk: Writing and submitting the manuscript. Mariem Mohamed: Writing, supervizing, and approving the revised manuscript. Rim Hadhri: Wiriting the histological part of the manuscript. Jameleddine Zili: Supervising and approving the revised manuscript.

ACKNOWLEDGEMENTS

None.

CONFLICT OF INTEREST

None.

DATA AVAILABILITY STATEMENT

We choose this statement of data availability: Data openly available in a public repository that issues datasets with DOIs.

ETHICAL APPROVAL

Approved.

CONSENT

Approved by all authors. Written informed consent was also obtained from the patient to publish this report in accordance with the journal’ patient consent policy”.