Abstract:

Leukemia cutis is usually diagnosed in patients with a known history of leukemia. Occasionally the skin is the presenting organ, making the clinical impression misleading. We present a case of a 56-year-old female without significant past medical history who presented to the dermatologist’s office with an erythematous maculopapular eruption over the trunk, arms, and legs as well as non-palpable purpuric macules on the thigh, not attributed to her karate practice. Three weeks prior, she was treated with oral penicillin for group-B streptococcal pharyngitis. The dermatologic impression was of a drug eruption, “post-streptococcal dermatitis” or a viral exanthem. Two skin biopsies were performed and a complete blood count (CBC) was ordered. The biopsies showed a superficial perivascular and interstitial infiltrate of atypical monocytic type cells. Immunohistochemical stains revealed that the cells were positive for lysozyme and KP1 (CD68). The biopsies were interpreted as “Cutaneous involvement by a lymphoproliferative infiltrate, worrisome for leukemia cutis”. Subsequently, her CBC revealed a marked leukocytosis, thrombocytopenia, and anemia. The diagnosis of acute monocytic leukemia was eventually made on bone marrow aspirate. The cutaneous lesions in the patients with leukemia can be seen before the development of leukemia (2%-3% cases) or concomitant with the diagnosis (23-44% of cases). Most commonly it develops after the diagnosis of leukemia (55-77% cases). In clinical practice, acute myeloid leukemia and chronic lymphocytic leukemia are most frequently associated with leukemia cutis. The clinical presentation in cases of leukemia cutis is diverse and may be obscured by confounding clinical history.

Financial Disclosure:
No current or relevant financial relationships exist.

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Ruchi Patel, MD