Appearance of Granuloma and Prurigo Pigmentosa after Land Leech Bites

Abstract

　　A 65-year-old man visited our department because of 3 nodules that had appeared 6 months earlier in the lower jaw and left lower leg. One month before presentation, papules appeared and spread across his body. Palpation revealed a soft nodule in the lower jaw and relatively hard nodules in the left lower leg. Biopsy of the nodules showed moderate-sized cell infiltration in the middle to lower dermis and mononuclear cells (mainly lymphocytes) with many eosinophils in the adipose tissue. Histochemistry confirmed CD4-positive and CD8-positive cells, but not CD30-positive larger lymphocytes. Accordingly, psuedolymphoma was diagnosed. Two months later, prurigo pigmentosa appeared on the trunk, and minocycline (200 mg/day; p.o.) was effective to some degree. Both eruptions were thought to be induced by land leech bites.