Erythema Migrans

[zsuzsiB]

I have CLL/SLL , diagnosed in 2010. Have been taking BTK inhibitors since 2017. First Imbruvica and the last two and a half years Calquence. A small reddish spot appeared on my arm in the middle of June. It started to spread. I did not pay much attention. End of July I showed it to my oncologist who said it is not a bruise, should see a dermatologist. The dermatologist did not think it was a skin issue, but took punch biopsy anyway. Both doctors asked if I may have been bitten by a tick. If I was, I did not notice. So went to Urgent Care who put me on Doxycycline for 21 days in case it was Lyme disease. I have one more week to go, but the red area is much bigger and darker. The biopsy said the skin is normal except there are numerous extravasated erythrocytes in the dermis. At this point I am not sure if this is related to Lyme, or CLL or Calquence, or something other. Not sure how to proceed. Did anyone have a similar experience? I would appreciate any insight. Thank you

[SofiaDeo]

I had numerous skin problems on ibrutinib. My biopsies came back eczematous plus several infections (fungal and bacterial). Blistering/peeling of the skin has been reported, as well as other skin problems. With the skin and GI issues I also had, I stopped the medication.

[gardening-girl]

zsuzsiB, I think that you can be thankful that you received the doxycycline treatment as soon as you did, even without a Lyme diagnosis!

In May, I removed an attached black legged/deer tick nymph from my leg, a tick so small that it took a magnifying glass to even identify it as a tick. Over the next few days I had an ever increasing red area around the bite, I guess it was erythema migrans without a typical target manifestation. A few days later I experienced extreme fatigue and fever, and felt worse than I'd felt in years, both physically and mentally. At my husband's urging I made an appointment with my PCP who prescribed a 21-day course of doxycycline. Within a couple of days I had recovered, and thankfully I think that the Lyme's was eliminated.

I'm on ibrutinib, and I don't whether that had any affect on my reaction to the bite or not.

gardening-girl in Tennessee USA

[zsuzsiB in reply to gardening-girl]

Thank you, Gardening Girl. I am glad you recovered so fast. Did the red area stopped expanding as soon as you started treatment and how long it took to disappear? Have you had any blood test after the treatment?Thank you again for your reply.

[gardening-girl in reply to zsuzsiB]

Yes, the red area did stop expanding, but I don't remember how long it took it to fade. I did not have any follow-up blood tests. Actually the antibody test done before starting treatment was negative, but apparently that is common with early Lyme infections. An antigen test would probably have been positive, but that wasn't done.

[zsuzsiB in reply to gardening-girl]

Thank you again. I will see my GP in a week. Maybe by than my big red area will look better.

[CycleWonder]

I was bit by a tick, not the very tiny ones but a deer tick. I developed a red circle around the bite and I was out in the antibiotic. The red circle slowly faded from red back to normal. It did not increase in size or turn brown. Similarly with my husband. I think the tick jumped off him and then onto me even though we washed every item of our bedding.

He had the “ring”. I just had a circle.

[zsuzsiB in reply to CycleWonder]

Thanks for your feed back. Looks like tick bites have all kind of manifestations. Appreciate the information.

[bayside64]

I developed a hematoma, bleeding under the skin from Calquence. It’s one of the side effects.

[zsuzsiB in reply to bayside64]

Did you stop taking Calquence? This is the first for me,. I have been taking Calquence for years and Imbruvica before that. Thank you for your reply.

[janvog]

With CLL and any of the targeted therapies, and "old age'' the wearing of arm protectors helps to avoid some skin issues and reduce the appearance of bruises. The wearing of the arm protectors also remind to be careful. Arm protectors are like thick cotton++ stockings worn over the middle of the hand (leaving only the fingers exposed) up to few inches below the armpits. A pair costs less then $ 20 and they last for years. They should be washed with water and some liquid soap each day. A protection that reduces the number of problems. I also wear white cotton gloves to protect my fingers, and for household tasks, over them also surgical gloves. The daily effort is better then need for medical treatment for irritations on the arms and hands. White dermatology gloves are inexpensive.

[zsuzsiB in reply to janvog]

Thank you for the tips🙏

[bayside64]

Yes, I stopped Calquence after 2 pills. I also had a bleed, hematoma, from Zanabrutinib after 2 or 3 pills. I can't tolerated BtK inhibitors. My body reacts to the side effect of bleeding.You'll be fine, since you are on it for a while. Do let your physician know of any concerns.

[zsuzsiB in reply to bayside64]

Thank you so much for your encouragement. I hope you have found a therapy that agrees and works for you.