Presentation
Our patient died 5 weeks following initial presentation. [mdedge.com]
The section Cases presents brief case reports that convey clear, practical lessons. Preference is given to common presentations of important rare conditions, and important unusual presentations of common problems. [cmaj.ca]
@article{732a1d02ab9142baa3aa8e0406897136, title = "Rare case of leukemia cutis presenting as erythroderma in a patient with acute myeloid leukemia", keywords = "acute myeloid leukemia, cutaneous leukemia, erythroderma, exfoliative dermatitis, leukemia [scholars.northwestern.edu]
Presentation may precede (aleukemic LC), coincide with, or manifest as recurrence of acute leukemia Most cases present after diagnosis of systemic leukemia < 10% present prior to blood or bone marrow involvement (aleukemic LC or primary extramedullary [basicmedicalkey.com]
Case Presentation: A 49‐year‐old man presented with a diffuse, nontender, nonpruritic papular exanthem. He stated that it started on the chest and spread to his back and extremities. [shmabstracts.com]
Entire Body System
- Pallor
He had pallor. A clinical differential diagnosis of Sweet's syndrome, bullous fixed drug eruption and purpura fulminans was considered. His hemoglobin was 9.1 g/dl. Total and differential counts were normal. [ijdvl.com]
Anaemia : pallor, tiredness, breathlessness. Reduced neutrophil count: bacterial, viral, fungal infections often with unusual or opportunistic organisms. Reduced platelet count ( thrombocytopenia ): easy bruising, bleeding. [dermnetnz.org]
General examination revealed pallor and lymphadenopathy. Cutaneous examination showed multiple hyperpigmented nodules and plaques involving face, trunk, and extremities [Figures 1 and 2 ]. [ncbi.nlm.nih.gov]
Due to a wound infection, he was examined by an infectious disease specialist in which the patient was pallor, normal vital signs (blood pressure: 135/68 mm Hg, heart rate: 89 beats per minute), and subfebrile (axillary body temperature: 37.1°C). [woundsresearch.com]
Patients present with signs and symptoms of pancytopenia such as bleeding, fatigue, exercise intolerance, pallor, and fever or focal signs of infection. This minor surgery is done under general anesthesia. [splithatchet.com]
- Ecchymosis
Spain This item has received 1192 Visits Article information Abstract Full Text Bibliography Download PDF Statistics Abstract Dermatologic manifestations of leukemia can be both specific and nonspecific (e.g., opportunistic infections, purpura and ecchymosis [actasdermo.org]
The most common nonspecific signs are hemorrhagic, including petechiae, purpura and ecchymosis. [ncbi.nlm.nih.gov]
Nonleukemic skin lesions are mostly a manifestation of bone marrow failure and include petechial bleeding, purpura, ecchymosis, and cutaneous signs of infection. 7 Nonleukemic skin lesions are more common than LC, as they occur in 40% or more of patients [woundsresearch.com]
Skin
- Papule
Figure 1: (a) Clinical photograph showing macules and papules on the face and anterior chest wall. (b) Clinical photograph showing macules and papules on the legs. [ccij-online.org]
Clinical image shows 2 small papules in a patient with acute myeloid leukemia. Histologic examination confirmed leukemic infiltrates consistent with myeloid sarcoma. (Courtesy V. Tonkovic-Capin, MD.) [basicmedicalkey.com]
He has nonerythematous, well‐demarcated flesh‐colored papules and plaques on the trunk and extremities (see Fig. 1 ). White blood cell count is 44 with 77% immature mononuclear cells. [shmabstracts.com]
Clinical examination revealed extensive erythematous, firm papules distributed over her trunk, neck and limbs (Fig. 1). There was no mucosal involvement, lymphadenopathy or organomegaly. [medicaljournals.se]
Typical clinical features include multiple red to purple papules, macules and nodules due to direct infiltration of the skin by malignant cells. We illustrate these cutaneous findings in a patient with congenital leukemia and tetralogy of Fallot. [jcnonweb.com]
- Skin Lesion
Three cases of LC presented with diverse skin lesions ranging from an erythematous rash to violaceous macules and papules to subcutaneous nodules. One case clinically mimicked fixed drug eruption. All the patients had acute myeloid leukemia (AML). [escholarship.org]
Clinical remission of skin lesions after the salvage therapy with FLAG regimens. [bmrat.org]
Leukaemia cutis is a rare condition in which leukaemia cells are found in the skin tissue. This infiltration of the skin causes visible patches or lesions to appear which can be a distinctive sign of a person having leukaemia. [leukaemiacare.org.uk]
Majority of skin lesions occur in patients already diagnosed with leukemia (55 to 77%), cutaneous lesions may appear at the presentation of systemic leukemia (23 to 44%), or even precede the development of leukemia in the peripheral blood and/or bone [ncbi.nlm.nih.gov]
However, the survival rate drops to 6 percent among people with the skin lesions. [healthline.com]
- Cutaneous Manifestation
In addition, an extensive section deals with the many and varied nonspecific cutaneous manifestations of this group of diseases. [annals.org]
Abstract Leukemia cutis (LC), a rare cutaneous manifestation of leukemia, can precede, follow, occur concurrently with, or present in the absence of (aleukemic) systemic leukemia. [escholarship.org]
Conclusions: The purpose of reporting this case is to appreciate leukemia cutis as a cutaneous manifestation of AML. Author Disclosure: A. deFonseka, none; J. Breaux, none. To cite this abstract: Breaux J, deFonseka A. [shmabstracts.com]
This skin involvement can be due to infiltration of skin by leukemic cells or it may be a part of nonspecific cutaneous manifestations. [ccij-online.org]
J Cutan Pathol. 2010;37:390-5. [ Links ] 13 Teresa S. Wright. Cutaneous manifestations of malignancy. Curr Opin Pediatr. 2011;23:407-11. [ Links ] 14 Wagner G, Fenchel K, Back W, Schulz A, Sachse MM. [scielo.br]
Workup
The traditional backbone of initial workup of AL, of acute leukemia, is composed of ctyomorphology, cytochemistry, immunophenotyping, and molecular cytogenetics. These techniques are the backbone of the initial diagnostic workup of acute leukemia. [ivoox.com]
The patient’s laboratory workup revealed the following results: hemoglobin, 5.5 g/dL (reference range, 13–18 g/dL); platelets, 128×109/L (reference range, 150–400×109/L); total white blood cell count (24.0×109/L [reference range, 4.0–11.0×109/L]), consisting [mdedge.com]
If the patient develops high unrelenting fevers, especially during the course of treatment, an infectious workup is necessary as these patients are immunocompromised and prone to infections. [ncbi.nlm.nih.gov]
Clinical Testing and Workup Laboratory tests will include a complete blood count and a peripheral blood smear. [rarediseases.org]
Serum
- Cytopenia
While cytopenia alone could be just a common side effect of azacitidine, the combination of cytopenia, rising peripheral blasts and diminishing clinical condition of the patient (fever without evidence for infection) was interpreted as progressive disease [frontiersin.org]
A complete blood count and peripheral smear must be performed to assess abnormalities in cell counts (cytopenias generally present) and evidence of circulating leukemic cells. [ncbi.nlm.nih.gov]
Microbiology
- Candida
Blood cancer patients with open wounds are more prone to infectious agents such as herpes simplex virus (HSV) or candida species (cause of thrush). [leukaemiacare.org.uk]
Treatment
That means treatments designed to remove or reduce lesions should be done in combination with systemic treatment for leukemia itself. [healthline.com]
Consequently, LC vanished after these treatments 15. [bmrat.org]
“Identifying a cohort of patients who may benefit from more intensive treatment is clinically relevant. However, having more intensive therapy may not necessarily improve treatment outcomes,” he cautioned. [cancernetwork.com]
Other treatments include electron beam therapy, localised radiation, and phototherapy. Fever usually indicates infection and requires investigation and treatment with systemic antibiotics, antifungal and antiviral treatment. The prognosis is poor. [dermnetnz.org]
Therapy-related acute myeloid leukaemia (t-AML) is a complication following exposure to cytotoxic agents used in the treatment of various primary malignancies (1). [medicaljournals.se]
Prognosis
Poor prognosis Generally a manifestation of disease progression Leukemia cutis in context of congenital myelogenous leukemia is an exception Not associated with worse prognosis Spontaneous regression of LC without treatment has been observed Prognosis [basicmedicalkey.com]
A diagnosis of leukemia cutis generally portends a poor prognosis and strongly correlates with additional sites of extramedullary involvement. [ncbi.nlm.nih.gov]
Previous reports have suggested poor prognosis for patients with LC, but these reports have largely consisted of descriptive studies with a limited number of patients. [jamanetwork.com]
Because it correlates with sites of additional extramedullary involvement, it typically portends a poor prognosis. [mdedge.com]
Leukemia cutis is especially rare as the presenting symptom of leukemia and is associated with a poor prognosis. [escholarship.org]
Etiology
Both genetic and environmental components are involved in the etiology of any leukemia and are responsible for maturation arrest and clonal expansion of precursor cells. [ncbi.nlm.nih.gov]
Leukemia cutis commonly used to describe lymphocytic leukemias involving skin Designated by precursor B- or T-cell lineage and chronic lymphocytic leukemia “Myeloid sarcoma” is preferred term when leukemic cells are of myeloid or monocytic lineage ETIOLOGY [basicmedicalkey.com]
Depending on the lesion’s appearance, the differential diagnoses can include lymphoma, drug eruptions, infectious etiologies, sarcoidosis, metastases from other malignancies, and blistering dermatoses. [mdedge.com]
The etiology for bullae is less well understood. No association has been found with the type of leukemia cutis and butterfly rash. It only highlights one of the unusual modes of presentation. [ijdvl.com]
Bacterial, fungal, and mycobacterial cultures should also be obtained to evaluate for possible infectious etiology [9]. Our patient’s lesions were a cutaneous manifestation of his underlying plasma cell leukemia. [cureus.com]
Epidemiology
[…] involve coexpression of cutaneous lymphocyte antigen (CLA) and its interaction with specific chemokines Other factors may include CCR4, TARC, and CCL22 Predilection for sites with cutaneous inflammation (e.g., Sweet syndrome, psoriasis) CLINICAL ISSUES Epidemiology [basicmedicalkey.com]
Leukemia cutis - epidemiology, clinical presentation,and differential diagnoses. J Dtsch Dermatol Ges. 2012;10:27-36. [ Links ] 15 Lee E, Park HJ, Cho BK, Lee JY, Lee S. Leukemia cutis as early relapse of T-cell acute lymphoblastic leukemia. [scielo.br]
View Article : Google Scholar : PubMed/NCBI 4 El-Serag HB and Rudolph KL: Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 132:2557–2576. 2007. [spandidos-publications.com]
Leukemia cutis - epidemiology, clinical presentation, and differential diagnoses. J Dtsch Dermatol Ges. 2012 Jan; 10 (1):27-36. [ PubMed : 22115500 ] 11. Paydaş S, Zorludemir S. Leukaemia cutis and leukaemic vasculitis. Br. J. [ncbi.nlm.nih.gov]
(This is an excellent recent review of the clinical manifestations, epidemiology, and histopathology. It discusses and compares the histopathology and immunophenotypes of several types of LC. There are several clinical and histologic photographs.) [dermatologyadvisor.com]
Pathophysiology
The pathophysiology of leukemia cutis involves the migration of leukemic cells into the skin. [ncbi.nlm.nih.gov]
Pathophysiology All types of leukemia result from the abnormal development of leukocytes in the bone marrow. [emedicine.medscape.com]
In the latter, a drastic change in chemotherapy regimen will be needed. [11] LC is often associated with many other sites of extensive involvement, and generally a very poor prognosis has been noted. [12], [13], [14], [15] The pathophysiology and mechanism [ijmpo.org]
[…] molecule-1 and lymphocyte function-associated antigen-1 has been hypothesized to be involved. 113 Future studies Establishing the underlying molecular basis for the migration of leukemia cells to specific sites is critical to understanding the specific pathophysiology [bloodjournal.org]
Prevention
Antimicrobials Most patients will also receive antimicrobials as a preventative measure against infections after these skin lesions are found. [leukaemiacare.org.uk]
Salvage chemotherapy has been applied successfully to prevent the development of LC in the patient's skin. Introduction Leukemia cutis (LC) is known as a general term for skin lesions caused by leukemia 1. [bmrat.org]
[…] skin relapse. 8 It has been suggested that aggressive chemotherapy should continue even after remission to prevent further relapse. 2 The prognosis of leukemia cutis tends to be grave, with 88% of patients dying within one year of diagnosis. 1,3,5 Another [the-dermatologist.com]
[…] therapy using radiation: electron beam, surgery, or light therapy to remove or reduce skin lesions Topical treatments: steroid creams, lidocaine, or other medications to relieve the pain and other symptoms Antimicrobial medications: medications to help prevent [healthline.com]
Therefore, new research directions are crucial to predict, prevent and combat virus diseases. This Special Issue will include manuscripts on different aspects of virus diseases in both humans and animals. [mdpi.com]