Condensed Case

A 65-year-old grandmother, Ms. L. was recently bitten by mosquitoes while she was gardening. This time, her experience with mosquito bites was different than previously. She noticed that despite her normal routine of rubbing alcohol and Calamine lotion on her bites, her bites became suppurative, bumpy, and large. She decided to seek medical attention from her internist. After prescribing steroids and applying a topical antibiotic, the internist ordered a CBC just as a precaution. Two days later, Ms. L was called back into the office. Her results were WBC 65 X 109/L, Hct 33, and platelets 150 X 109/L. A differential was ordered as part of reflex testing and revealed 99% mature lymphocytes Are the results of this differential in the normal reference range?

Answer

Clearly, this is an unexpected case of CLL. While it is unusual to have a severe cutaneous response to mosquito bites, the fact that the lymphocytic cells in CLL are compromised and unable to provide proper immune response certainly contributes to this unusual presentation. Ms. L will probably do well with little intervention. She will need to be followed as the disease progresses.

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Table 13.7 O

Overview of Major Malignant Lymphoproliferative Disorders

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