Hirudotherapy – a rare cause of pseudolymphoma

Cutaneous pseudolymphoma (C-PSL) represents a heterogeneous group of cutaneous reactions characterized by polyclonal T and/or B cell proliferation [1, 2]. The disease can be either idiopathic or triggered by various stimuli including infections, primarily Borrelia burgdorferi and drugs [3, 4]. Several lines of evidence indicate minor traumas such as tattoos, acupuncture, insect bites and vaccination as C-PSL inducers [3, 4]. Herein, we present a rare case of a C-PSL provoked by hirudotherapy.
A 38-year-old woman was admitted to the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, for diagnosis and treatment of skin lesions that appeared 7 months before hospitalization. On admission, physical examination revealed 10 well-defined, firm and pruritic nodules, red in color, ranging from 6 to 10 mm in diameter in her pubic area (Figures 1 A, B). The skin changes appeared soon after the patient underwent hirudotherapy that had been recommended by her friend as a successful treatment for uterine myoma. The pruritic cutaneous lesions appeared after the first procedure, however the patient decided to apply the second therapy after 3 weeks. Each time 5 leeches were used. For the apparent skin lesions the patient was given oral antihistamines and moderate potent topical glucocorticosteroids with no improvement. The patient did not take any other medicines, except for ulipristal acetate 5 mg/day, orally, administered by a gynecologist for the uterine myoma.
Laboratory tests (morphology, urinalysis, lipids, liver function, renal function and inflammation markers) were within normal ranges. Histological examination of the skin biopsy revealed irregular acanthosis and mixed-cell infiltration, composed of lymphocytes, histiocytes, plasma cells and eosinophils in the dermis. An evident exocytosis with focal spongiosis and intraepidermal inflammatory infiltration were observed. In the immunohistochemical study, the lymphocyte population consisted of a mixed population of T and B lymphocytes with T cell predomination. The T lymphoid cells were positive for CD3, CD43, CD45RO, CD4, CD8, CD30, CD20, CD79a, CD138. The numerous epithelioid histiocytes were CD68 positive. The proliferative rate measured by Ki-67 expression was low (labeling index = 7%). Based on the histological, immunohistochemical results and clinical observations the diagnosis of C-PSL was made.
Initially, the skin changes were treated with 100 mg...


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