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Case Reports

Abstract

Introduction: Leukemia cutis (LC) is a rare condition in which neoplastic leukocytes infiltrate the skin, resulting in a wide spectrum of nonspecific cutaneous manifestations. Herein, we present a patient with acute myeloid leukemia (AML) relapse who presented with a tender truncal rash, which was found to be LC secondarily infected with methicillin-resistant Staphylococcus aureus (MRSA). Case: A 48-year-old female admitted for AML relapse and neutropenic sepsis was evaluated for a painful, ulcerating rash which began, two weeks prior to presentation, on her abdomen and spread to her chest. Few scattered erythematous, round plaques and papulonodules, some with central heme crust and collarette scale, were present on abdomen and chest, with the largest of these lesions with central black eschar. MRSA nares resulted positive. Preliminary pathology findings from abdominal skin biopsy favored bacterial folliculitis with reactive inflammatory response in setting of AML, with lower suspicion for LC and sweet syndrome but atypical mononuclear cells were noted in the background. Final pathology results showed LC with gram stain positive for numerous gram-positive cocci. PAS-D and GMS stains were negative. AFB and Fite stains were negative. Skin cultures were positive for few MRSA. Patient refused chemotherapy for AML. Daptomycin improved skin lesions. Discussion: Skin and soft tissue secondary infection of LC is rarely reported. As hematologic remission from leukemia subtype-specific systemic treatment usually improves LC, this case underscores the utility of immunohistochemical staining to not only distinguish neoplastic from reactive infiltrates but also evaluate for overlying infection, and if present, supplement treatment with antibiotics.