By Gary M. White, MD

Hypersensitivity to mosquito bites (HMB) goes beyond the usual itchy wheal at the bite site. The patient with HMB may experience bulla, ulceration, necrosis and/or scarring at the bite site and systemic symptoms such as high fever, lymphadenopathy, hepatosplenomegaly, hepatic dysfunction, hematuria, and proteinuria. Natural killer cells proliferate in abnormally high amounts in the skin lesions and blood in patients with HMB. The finding of clonal Epstein-Barr virus (EBV) DNA-positive natural killer cells suggests this is an EBV-associated lymphoproliferative disease. The majority of patients are from Japan or Korea and less than 20 years of age.

Of note, hydroa vacciniforme also falls within the Epstein-Barr virus (EBV)-associated T/natural-killer lymphoproliferative disorders.


An 18-year-old Korean boy presented with an erythematous 4 cm nodule on his left lower leg after a mosquito bite. The lesion then evolved into a necrotic and hemorrhagic ulcer. Regional lymphadenopathy was observed. Biopsy of the skin lesion revealed anaplastic large cell lymphoma. Korean J Fam Med. 2015 Jan;36(1):35-41

A 6-yr-old Korean boy presented with severe reactions in response to mosquito bites. Specifically, he would develop erythematous swellings and bulla formation at the bite site with fever, regional lymphadenopathy and/or phlebitis. The skin lesions evolved into necrotic ulcers and healed with residual scarring. J Korean Med Sci. 2013 Jan; 28(1): 164–166


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