Submitted to: American Journal of Medicine
Publication Type: Peer reviewed journal
Publication Acceptance Date: 12/1/2011
Publication Date: 5/7/2012
Citation: Deshazo, R.D., Feldlaufer, M.F., Mihm, M.C., Goddard, J. 2012. Bullous reactions to bed bug bites reflect cutaneous vasculitis. American Journal of Medicine. 125:688-694. Interpretive Summary: The resurgence of bed bugs has led to a need for recognizing the specific skin reaction to bites that may occur after being bitten by these blood-sucking pests. We have followed the bite reaction to bed bugs in a sensitive individual, and have photographically documented the progression of the reaction. This research will be helpful to health care professionals interested in recognizing the symptoms of bed bug bites, and also may be useful in determining any appropriate treatment.
Technical Abstract: This study evaluates bullous cutaneous reactions and sequential histopathology in an individual sensitized to bed bug bites in an effort to better understand the allergic response and histology associated with these bites. There was a progression of the inflammatory response across time ranging from an urticarial-type reaction with edema, mast cell degranulation, and a mixed cellular infiltrate at 0.5h to an inflammatory vasculopathy with a mixed celluar infiltrate by 6h. By 24h, there was a destructive, necrotizing, eosinophil-prominent vasculitis. The mast cells were focally degranulated in several of the specimens where they correlated with edema. An unusual component of these reactions was the prominent infiltration of CD68+ histocytes. To our surprise, bullous reactions in this individual evolved over time into cutaneous vasculitis that favored, in part, a delayed hypersensitivity mechanism.