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Chronic lymphocytic leukaemia/small lymphocytic lymphoma is the most common adult leukaemia [1]. The disease in its initial stages mostly involves the bone marrow and lymph nodes, with other sites being infrequently affected [2]. Skin infiltration in CLL/SLL is seen in 1-2 % of cases [3]. Skin involvement is a rare initial presentation of the disease. One study showed that skin infiltration by tumour cells was the initial manifestation in 7 patients (16.7%) from a series of 42 patients with B-CLL/SLL [4]. Borrelia burgdorferi infection has been linked to skin manifestations of CLL/SLL [5]. A 65-year-old male patient from a rural area presented to the General Practitioner’s office with a slow-growing nodule of the right nipple. The patient was referred to the Surgery Department of the “Prof. Dr. Ion Chiricuță” Oncology Institute. In our department, the patient reported that he had noticed the lesion four months prior to the current presentation, with a progressive, slow-growing, painless evolution. The patient’s family history revealed two first degree relatives with haematological diseases. One of the patient’s sons was diagnosed with a form of acute leukaemia, from which he subsequently died at the age of 33. The patient’s mother also suffered from a form of haematological malignancy. The patient was not able to give further details regarding the diseases of his relatives. He had been a smoker since the age of 14, with an average of one pack of cigarettes per day. He also reported occasional alcohol consumption, but denied any consumption of drugs or narcotics. There was no other significant history. Clinical examination showed facial erythema, a good state of nutrition, a blood pressure of 160/80 mm Hg, a heart rate of 80 bpm, and a body temperature of 36.8°C. In the right nipple area, a nodular lesion with a diameter of 2 cm was present. The skin overlying the lesion was erythematous, but showed no ulceration. On palpation, the tumour had a hard consistency. Bilaterally, in the lateral cervical, submandibular and axillary areas, several enlarged lymph nodes less than one centimetre in diameter were identified. No liver or spleen enlargement was found on abdominal examination.

Chronic Lymphocytic Leukaemia/Small Lymphocytic Lymphoma Skin Infiltration Triggered by Borrelia Burgdorferi Infection