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. He has acute myeloid leukemia (AML), subtype acute myelomonocytic leukemia (M4), with documented regression on bone marrow 2 months prior to presentation. Unfortunately, the patient did not follow up with oncology after his successful induction chemotherapy. He has nonerythematous, well‐demarcated flesh‐colored papules and plaques on the trunk and extremities (see Fig. 1). White blood cell count is 44 with 77% immature mononuclear cells. Biopsy of skin lesions shows fibroadipose tissue infiltrated by a monobiaslic sarcoma. The bone marrow is 95%‐100% cellular. Normal hematopoietic elements have been almost entirely replaced by large blasts. Therefore, the patient is diagnosed with AML relapse with leukemia cutis. Prior to initiation of salvage chemotherapy, the patient developed acute respiratory distress. Despite advanced cardiac life support, he could not be resuscitated.
AML is a bone marrow malignancy in which hematopoietic precursors are arrested in an early stage of development. This leads to decreased production of normal blood cells (anemia, thrombocytopenic, neutropenia) and accumulation of precursor cells in the bone marrow (typically greater than 20% blasts), spleen, and liver. The Revised FAB classification of AML divides the disease into 8 subtypes (M0–M7) based on the degree of maturation and lineage of leukemic blasts. M4 accounts for 15%–20% of AML. Leukemia cutis is the infiltration of neoplastic leukocytes into the skin. AML has the second highest rate of leukemia cutis after adult T‐cell leukemia/lymphoma. Of all AML subtypes, M4 and acute monocytic leukemia (M5) have the highest rate (up to 30%) of ieukemia cutis, possibly reflecting the tendency of nonneoplastic monocytes to extravasale into these tissues. Leukemia cutis can present as macules, papules, nodules, indurated or hemorrhagic plaques, ulcers, bullae, or palpable purpura. Treatment is chemotherapeutic eradication of the underlying leukemia. However, in resistant or recurrent skin disease, local therapy in the form of electron beam therapy may be used. The prognosis is poor. Although 60% of treated patients with AML achieve complete remission, only 15%–30% are disease free at 5 years.
The purpose of reporting this case is to appreciate leukemia cutis as a cutaneous manifestation of AML.
A. deFonseka, none; J. Breaux, none.
To cite this abstract:Breaux J, deFonseka A. Leukemia Cutis: Presentation of Acute Myeloid Leukemia Relapse. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 223. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/leukemia-cutis-presentation-of-acute-myeloid-leukemia-relapse/. Accessed May 27, 2019.