{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T06:52:12Z","timestamp":1776840732889,"version":"3.51.2"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe mosquito bite allergy (SMBA) is characterized by intense local necrotic skin reactions accompanied by systemic symptoms following mosquito bites. SMBA is currently classified within the spectrum of EBV-positive T\/natural killer (NK)-cell lymphoproliferative disorders (LPDs) and is recognized as a specific cutaneous manifestation of chronic active EBV disease (CAEBVD), with a potential risk of progression to overt T\/NK-cell leukemia or lymphoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>Herein, we report a rare case of a 70-year-old male diagnosed with EBV-associated NK-cell LPD manifesting primarily as SMBA. The patient presented with recurrent disseminated erythematous plaques, bullae, necrotic ulcers, and scarring following mosquito bites, accompanied by intermittent fever. Quantitative PCR revealed a high EBV DNA load in peripheral blood, and skin biopsy demonstrated an angiocentric infiltration of EBV-positive NK cells. Based on the clinical features of SMBA, high EBV load, and histopathological findings, the diagnosis of EBV-associated NK-cell LPD was established. Treatment with oral prednisone and methotrexate resulted in significant clinical improvement, and the patient maintained a stable, indolent course during the subsequent 2-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We report a rare case of elderly-onset EBV-associated NK-cell LPD manifesting as SMBA, characterized by an unusually indolent clinical course. Furthermore, we provide a comprehensive literature review of 9 previously reported adult SMBA cases to offer insights for clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1789094","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:53:03Z","timestamp":1776837183000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A case of severe mosquito bite allergy in an elderly patient"],"prefix":"10.3389","volume":"17","author":[{"given":"Huizhong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Department of Dermatology, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Department of Dermatology, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwen","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Department of Dermatology, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Department of Dermatology, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liuqing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital","place":["Wuhan, China"]},{"name":"Department of Dermatology, 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