|Year : 2000 | Volume
| Issue : 5 | Page : 266-267
Skin changes in acute myelogenous leukemia
RR Mittal, Jastinder Kullar, PS Sethi, Puneeth
R R Mittal
Source of Support: None, Conflict of Interest: None
A 65-year old woman developed progressive, firm, mild to moderately itchy, erythematous, papular and nodular lesions, over cheeks, extensors of limbs, scalp and lower back without any accompanying systemic complaints except for severe backache. Initially clinical diagnosis was cutaneous sarcoidosis. However presence of myeloblasts, monoblasts, myelocytes and metamyelocytes in peripheral blood smear and typical histopathology of nodule with mixed cellular infiltrate more around blood vessels, sweat glands and hair follicles with admixture of larger polymorphonuclears (myeloblasts/myelocytes), eosinophils with double nuclei, and larger phagocytic cells confirmed the diagnosis of acute myelogenous leukemia (AML).
Keywords: Myelogenous leukemia, Myeloblast, Myelocytes
|How to cite this article:|
Mittal R R, Kullar J, Sethi P S, Puneeth. Skin changes in acute myelogenous leukemia. Indian J Dermatol Venereol Leprol 2000;66:266-7
|How to cite this URL:|
Mittal R R, Kullar J, Sethi P S, Puneeth. Skin changes in acute myelogenous leukemia. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 Aug 13];66:266-7. Available from: http://www.ijdvl.com/text.asp?2000/66/5/266/4944
| Introduction|| |
Skin is rarely involved in acute myelogenous leukemia and lesions can resemble pinkish papulonodules of cutaneous sarcoidosis.  Specific changes in skin may occur in the course of aleukemic, subleukemic, or leukemic myelosis.  Papules, nodules, tumor-like non-ulcerated plaques, haemorrhagic cutaneous blotches, and bullae are observed in myelosis.  Histopathologically, perivascular and periadnexal cellular infiltrate consisting of polymorphonuclears (PMNL), large PMNL with oval or round vesicular nuclei having foamy/clear cytoplasm and distinct cell outline (myelocytes/ myeloblasts) are observed in acute myeloid leukemia.  A case of myeloid leukemia of skin reported by Ketron and Hay histopathologically showed eosinophils with double nuclei, large phagocytic cells in addition to large PMNL with round to oval or irregular nuclei. 
| Case Report|| |
A 65-year-old woman developed numerous progressive, mild to moderately itchy, non tender bilateral symmetrical, pinkish/erythematous firm, well-defined, 0.5 to 1 cm in size papules to nodules on scalp, face, extensors of limbs and lower back since 3 months. Papulonodules were bigger and more in number on cheeks just below eyes and partial blanching was observed on diascopy. Seven days later she developed severe low backache and purpuric nodules more on buttocks. One plaque on left wrist showed superficial central ulceration and crusting. General physical and systemic examinations were normal except abdominal tenderness and two peasized, discrete, non tender, freely mobile right supraclavicular lymph nodes. Cutaneous lesions progressed and she died 1˝ months later after developing epistaxis, haematuria and shock. Investigation revealed Hb-8.4 gm%, BT-2'05", CT5'-15", platelet count - 70,000/cm, TLC-27,450 cells/cmm, DLC. N-15, L-03, M-03, E-01, B-02, metamyelocytes 16, myeloblasts 21, myelocytes 07 and monoblasts 32. Peripheral smear also revealed dimorphic population of RBC's, occasional nucleated RBC and myeloblast showed auer body. Urinalysis was normal. Her FBS was 70mg%, blood urea 32mg%, ESR 80mm in Ist hour, calcium- 11.Omg%, serum phosphorous - 4.3 mg% SGOT-1261U/L, SGPT-110 IU/L. TSP-6.7 gm% DSP-alb-3.5 gm% and glob-3.2 gm%.
Histologically well-defined groups of myeloblasts, myelocytes, metamyeolocytes, eosinophils with double nuclei, giant cells admixed with mononuclears, plasma cells and eosinophils around skin adnexa and blood vessels were seen in dermis. Overlying epidermis was normal.
| Discussion|| |
Skin lesions are rare in acute myelogenous leukemia and may be specific or non specific. Specific changes in skin are rarer in myelosis than the lymphadenosis.  Lymphadenosis is characterized histopathologically by small lymphocytes occasionally associated with plasma cells and specific lesions of myelosis show large PMNL simulating myeloblasts and varying degree of neutrophils, eosinophils, myelocytes, macromyelocytes, mast cells, nucleated erythrocytes and positive oxidase test.' Erythematous papulonodules of myelosis closely simulate cutaneous sarcoidosis or SLE. Clinically papules, nodules, ulcerated plaques to nodules, petechiae, and haemorhagic blotches are seen in myelosis and such eruption suggestive of lymphomas should alert dermatologists for immediate thorough investigations for myelosis.
| References|| |
|1.||Mackie RM. Cutaneous lymphocytic infiltrates and pseudolymphoma. In: Champion RH, Burton JL, Ebling FIG eds. Textbook of Dermatology. Oxford London. Blackwell Scientific Publications. 1992:2111. |
|2.||Barney RE Leukemic myelosis associated with specific nodules in the skin. Arch Dermatol 1933;27:725-37. |
|3.||Costello MJ, Canizares O, Montague M III, et al. Cutaneous manifestations of myelogenous leukemia. Arch Dermatol 1955;71:605-14. |
|4.||Ketron LW, Gay LN. Myeloid leukemia of the skin. Arch Derm Syph 1923;7:176-94. |