LEUKEMIA CUTIS: AN UNCOMMON PRESENTATION OF ACUTE MYELOID LEUKEMIA D Beyer MD2, M Lieux BS1, B Van Court BS1, C Pham BS1, C Van Dreumel MD2, R Foret MD2, N Nebeluk MD/Ph.D1, S Sanne DO2
1Department of Internal Medicine, LSU Health, New Orleans, LA 2School of Medicine, LSU Health Sciences, New Orleans, LA
INTRODUCTION: Leukemia Cutis is a rare condition characterized by infiltration of neoplastic cells into the epidermis and dermis with a characteristic dermatologic appearance. Leukemia cutis generally portends a poor prognosis in the setting of newly diagnosed blood cancers.
CASE: A 31-year-old man without a past medical history presented after 1 month of progressive dyspnea on exertion, worsening fevers, thirty-pound unintentional weight loss and diffuse rash on all extremities and trunk. Physical exam was significant for fever, tachycardia and scattered petechia and erythematous papules on his bilateral upper and lower extremities. Initial laboratory findings were significant for leukocytosis (222,000 k/uL) with 94% immature mononuclear cells and thrombocytopenia (8,000 k/ul). Punch biopsy was performed and pathology returned leukemia cutis with myeloid features. Bone marrow biopsy was significant for acute myeloid leukemia with 86% large blastoid cells. Patient was started on induction chemotherapy with cytarabine and idarubicin resulting in slow resolution of rash. DISCUSSION: Leukemia cutis is a challenging diagnosis and rare presentation of leukemia. When coupled with a new diagnosis of acute myeloid leukemia, as in this patient, portends a worse prognosis. This patient presented in blast crisis with cutaneous involvement and new diagnosis of acute myeloid leukemia was made promptly based on bone marrow biopsy results. Prompt dermatologic consultation resulted in diagnosis of leukemia cutis based on punch biopsy. After initiation of induction chemotherapy (cytarabine and idarubicin), his cutaneous lesions subsided significantly.
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