Track: Case Reports

Topic: Lymphoproliferative Disorders

Abstract:

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is one of the most common forms of leukemia. Patients can have numerous different presentations including asymptomatic complete blood count abnormalities, symptoms related to cytopenias such as infection or easy bruising, or constitutional B symptoms such as fatigue, fever, and night sweats. Leukemia cutis, cutaneous involvement by leukemic cells, is a rare complication of CLL/SLL. However, in patients who are otherwise asymptomatic, it can provide a key diagnostic clue for the early detection and treatment of disease. In this case, we present a 70-year-old woman with the initial complaints of flu-like symptoms and toe swelling with erythema who was subsequently found to have persistent leukocytosis. At that time, flow cytometry and biopsy of the toes revealed an expanded lymphocytic population consistent with CLL/SLL and an atypical dermal lymphoid infiltrate, respectively. Due to the limited stage of her CLL/SLL at presentation, the patient elected to proceed with close monitoring; however, she later developed lesions of the nail bed of her right first and second fingers. These were biopsied and revealed an atypical lymphocytic infiltrate comprised of small mature cells with an immunoprofile consistent with her known CLL/SLL. This case details a unique presentation of leukemia cutis primarily located within the subungual regions of multiple upper and lower extremities. It also demonstrates the importance of careful skin examination in the management and monitoring of CLL/SLL.

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Mackenzie Gwynne, MD