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   Abstract
   Introduction
   Case Report
   Discussion
   References
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CASE REPORT
Year : 1995  |  Volume : 61  |  Issue : 2  |  Page : 104-105

Chronic lymphocytic leukaemia presenting as chronic generalised erythroderma




Correspondence Address:
PVS Prasad


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Source of Support: None, Conflict of Interest: None


PMID: 20952905

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  Abstract 

A 40-year-old lady presented with pyrexia of unknown origin and chronic generalised erythroderma. The blood picture was of leukaemia and the cutaneous histopathology showed leukaemic infiltration of the dermis.


Keywords: Chronic lymphocytic leukaemia, Chronic generalised erythroderma


How to cite this article:
Prasad P, Balasubramaniam S, Arumainayagam D C, K. Chronic lymphocytic leukaemia presenting as chronic generalised erythroderma. Indian J Dermatol Venereol Leprol 1995;61:104-5

How to cite this URL:
Prasad P, Balasubramaniam S, Arumainayagam D C, K. Chronic lymphocytic leukaemia presenting as chronic generalised erythroderma. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 Sep 19];61:104-5. Available from: http://www.ijdvl.com/text.asp?1995/61/2/104/4158



  Introduction Top


Skin lesions in lymphomas and leukaemias can occur as a result of direct spread or as a secondary nonspecific effect. The direct spread produces plaque like, nodular, tumorous or ulcerative lesions. Nonspecific effects are responsible for pupuric lesions, pigmentation, pruritus, prurigo, ichthyosiform atrophy, alopecia, herpes zoster or exfoliative dermatitis (CGE).[1]

CGE, besides being associated with lymphomas, can also be seen to occur in various types of leukaemias.[2] Although CGE can occur in 25% of cases of T Cell leukaemias, the histological changes are not diagnostic.[3][4][5] CGE due to cutaneous infiltration of the skin by leukaemic cells can occur in 4.5% of patients with chronic lymphatic leukaemia and most of the cases are of T cell origin rather than the usual B cell type.[2]


  Case Report Top


A 40-year-old lady presented with high grade intermittent fever of one month duration and generalised exfoliation of the skin for three weeks. On examination, she was febrile and pale. Cervical, axillary and epitrochlear lymph nodes were enlarged, discrete, mobile and nontender. Cutaneous examination revealed chronic generalised erythroderma with generalised hypohidrosis. There were no other specific skin lesions. Systemic examination revealed bronchial breathing in the left infra axillary region with few crepitations. There were no significant findings in the cardiovascular system, central nervous system or in the abdomen. With a provisional diagnosis of PUO and CGE, the patient was investigated and the reports were as follows: Hb 8.4 g%, ESR 48 mm at one hour, FBS 80 mg/dl, PPBS 106 mg/dl, bleeding time 2 minutes & 5 seconds, clotting time 2 minutes & 40 second. Urinalysis was within normal limits, VDRL was nonreactive, and the Widal was-negative. A complete haemogram revealed a total count of 2,42,000 cells/cu mm, pletelat count of 2,10,000 /cu mm, the peripheral smear showed sheets of predominantly mature lymphocytes (94 %), occasional cells with cleaved nuclei and smudge cells [Figure - 1]. The peripheral blood features were suggestive of a chronic lymphocytic leukaemia. A skin biopsy from the left forearm revealed infiltration by leukaemic cells. A final diagnosis of chronic lymphocytic leukaemia with CGE was made and the patient was referred to the Haematology unit for further management.


  Discussion Top




  1. 1. This case reveals the necessity for thorough screening of all cases presenting with CGE to look for rarer aetiological factors.


  2. 2. The cutaneous histopathology showed the presence of dense collections of dermal lymphocytes, a feature seen in only 4.5 % of cases of leukaemis.[4]


  3. 3. There are no case reports of CGE with leukaemia in the Indian literature, and hence this report.




 
  References Top

1.Mackie RM. Lymphomas and Leukaemias. In:Text book of Dermatology (Champion RH, Burtom JL, Eblinh FJG, eds). 5th edn. Vol III. Oxford:Blackwell Scientific Publications, 1992;2110-2  Back to cited text no. 1    
2.Bonvalet D, Folders C, Civatte J. Cutaneous manifestations in chronic lymphocytic leukaemia. J Dermatol Surg Oncol 1984;10:278-80.  Back to cited text no. 2    
3.Beck CH. Skin manifestations associated with lymphomas & leukaemias. Dermatologica 1948;96;350-6.  Back to cited text no. 3    
4.Vonderheid E. Chronic generalised erythroderma. In:Difficult diagnosis in Dermatology (Mark Lebwohi, ed). 1st edn. New York:Churchull Livingstone, 1988;89-111.  Back to cited text no. 4    
5.Greenwood R, Barker DJ, Tring FC, et al. Clinical and immunological characterisation of cutaneous lesions in chronic lymphocytic leukaemia. Br J Dermatol 1985;113:447-50.  Back to cited text no. 5  [PUBMED]  


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