@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]

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]

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]

• Inguinal Lymphadenopathy

  Bilateral firm, fixed, nontender cervical, axillary and inguinal lymphadenopathy was present [Figure 1] a, c, e, and i. Rest general and systemic examination was within normal limits. [jahjournal.org]

• Intermittent Fever

  There were purpuric plaques and papules on the upper extremities with a few lesions showing central blistering for 10 days, along with intermittent fever. There was no other significant history. [ijdvl.com]

• Short Arm

  Cytogenetic testing showed a structural rearrangement between chromosomes 9 and 12 resulting in the deletion of their short arms (45,XX,-9,t(9;12)(q12;p1)). [cmaj.ca]

• Insect Bite

  bites Psoriasis Presentation 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 [basicmedicalkey.com]

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]

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]

• Treponema Pallidum

  Maternal serology, including TORCH, hepatitis B surface antigen, hepatitis C virus, venereal disease research laboratory and treponema pallidum hemagglutination assay, was negative. [jcnonweb.com]

• Liver Biopsy

  Liver magnetic resonance imaging (MRI) revealed a 6-cm mass in hepatic segments 4 and 8, and a liver biopsy demonstrated that hepatocellular carcinoma cells and immature blast cells coexisted. [spandidos-publications.com]

• Hypercellular Bone Marrow

  A bone marrow biopsy showed a hypercellular bone marrow (~95% cellularity) replaced by large myeloid blasts, some binucleated with a few eosinophilic granules in the cytoplasm, consistent with APL. [jcadonline.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]

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]

Treatment / Management Treatment of leukemia cutis points toward addressing underlying leukemia using aggressive systemic chemotherapy. Systemic chemotherapy for leukemia depends on cancer subtype. [ncbi.nlm.nih.gov]

Only 24 patients with APL have been reported to have developed LC.[22–26] Interestingly, in all of these cases, the rash appeared to be induced by treatment with ATRA.[22–26] ATRA treatment is associated with an increased incidence of extramedullary disease [jcadonline.com]

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]

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]

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]

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]

[…] 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]

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]

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]

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]

The donor site is also covered with a dressing to prevent infection from occurring. Cosmetic surgery is a type of plastic surgery that aims to improve a person's appearance, but it should be approached with caution. [splithatchet.com]