Risk of mortality in hydroa vacciniforme and hypersensitivity to mosquito bites.

Abstract

All listed authors meet ICMJE authorship criteria. ORIGINAL ARTICLE, p 56 Epstein–Barr virus (EBV) infection is a common occurrence in adolescence in developed countries, whereas in developing countries the age of infection is frequently 3–4 years.1 The long‐term sequelae of EBV infection are varied and include a spectrum of diseases from Burkitt lymphoma, Duncan disease and post‐transplant lymphoma, to chronic active EBV disease (CAEBV). For the dermatologist, classical hydroa vacciniforme (cHV) and hypersensitivity to mosquito bites (HMB) are two diseases associated with EBV infection that may present to the clinic. Despite having the commonality of EBV infection, the two skin diseases could not be more different. cHV presents with vesicles on sun‐exposed skin without any systemic symptoms, while HMB presents with cutaneous lesions at sites of insect bites or vaccinations and systemic symptoms of fever, splenomegaly and lymphadenopathy. Even more intriguing is that some cases of HV can present with systemic symptoms similar to those of HMB, but with the skin findings as in cHV. Some of these patients die, and earlier treatment provides some benefit.2 What has confused the clinician has been how to determine which patients with systemic symptoms require aggressive treatments such as stem cell transplants due to the associated mortality.