Dear Laurel

I wonder if your doctors have seen this paper?

Borrelia burgdorferi-associated cutaneous marginal zone lymphoma: a clinicopathological study of two cases illustrating the temporal progression of B. burgdorferi-associated B-cell proliferation in the skin. Goodlad JR, Davidson MM, Hollowood K, Batstone P, Ho-Yen DO. Histopathology. 2000 Dec;37(6):501-8.

Borrelia Burgdorferi is the bug that cause Lyme disease and it responds to antibiotics. I have treated one patient with marginal zone lymphoma of the skin with antibiotics with good response (although the lesions also respond well to local radiotherapy).

Since infections are common in CLL and do strange things it is worth thinking whether this may have happened. Have you ever been exposed to ticks from deer or cattle?