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Hypersensitivity reaction as a harbinger of acute myeloid leukemia: a case report and review of the literature.

Cohen JM, Cheng CE, DeSouza A, Nandi TR, Buzney EA, Larson A, Lee WY, Mostaghimi A - Ann Dermatol (2015)

Bottom Line: The evolution of the dermatitis to erythroderma coincided with the clinical presentation of AML, and was therefore considered to be a paraneoplastic syndrome.The patient decided against therapy and died seven weeks after diagnosis.Physicians should consider a cutaneous paraneoplastic syndrome when faced with dynamic recalcitrant dermatoses that are difficult to treat and decide on laboratory testing accordingly.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

ABSTRACT
Cutaneous paraneoplastic syndromes comprise a broad spectrum of cutaneous reactions to an underlying malignancy. These dermatoses are not the result of metastatic spread to the skin, but rather a reaction to the presence of malignancy. Cutaneous paraneoplastic syndromes often precede the identification of a malignancy. We describe the case of a 79-year-old man with a six-month history of recalcitrant treatment- resistant dermatitis. A complete blood count test performed at the time of initial presentation was normal. The patient ultimately presented with erythroderma and was diagnosed with acute myeloid leukemia (AML). The evolution of the dermatitis to erythroderma coincided with the clinical presentation of AML, and was therefore considered to be a paraneoplastic syndrome. The patient decided against therapy and died seven weeks after diagnosis. Physicians should consider a cutaneous paraneoplastic syndrome when faced with dynamic recalcitrant dermatoses that are difficult to treat and decide on laboratory testing accordingly. Patients should be evaluated regularly for two to three years after initial diagnosis with a physical exam and review of systems to monitor for signs and symptoms of malignancy.

No MeSH data available.


Related in: MedlinePlus

(A) Skin biopsy of the back showing superficial and deep atypical lymphoid infiltrate (H&E, ×20). (B) Focal interface dermatitis (H&E, ×40). (C) Associated lymphoctyic vasculitis (H&E, ×20).
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Figure 4: (A) Skin biopsy of the back showing superficial and deep atypical lymphoid infiltrate (H&E, ×20). (B) Focal interface dermatitis (H&E, ×40). (C) Associated lymphoctyic vasculitis (H&E, ×20).

Mentions: A skin biopsy of the back showed a superficial and deep atypical CD3+ CD2+ CD5+ lymphoid infiltrate with associated lymphocytic vasculitis and focal interface dermatitis (Fig. 4). Immunostaining of the skin biopsy failed to show evidence of a lymphoproliferative disorder. Ultimately, the clinical presentation and pathologic analysis of the biopsy specimens appeared most consistent with a paraneoplastic erythroderma.


Hypersensitivity reaction as a harbinger of acute myeloid leukemia: a case report and review of the literature.

Cohen JM, Cheng CE, DeSouza A, Nandi TR, Buzney EA, Larson A, Lee WY, Mostaghimi A - Ann Dermatol (2015)

(A) Skin biopsy of the back showing superficial and deep atypical lymphoid infiltrate (H&E, ×20). (B) Focal interface dermatitis (H&E, ×40). (C) Associated lymphoctyic vasculitis (H&E, ×20).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4377409&req=5

Figure 4: (A) Skin biopsy of the back showing superficial and deep atypical lymphoid infiltrate (H&E, ×20). (B) Focal interface dermatitis (H&E, ×40). (C) Associated lymphoctyic vasculitis (H&E, ×20).
Mentions: A skin biopsy of the back showed a superficial and deep atypical CD3+ CD2+ CD5+ lymphoid infiltrate with associated lymphocytic vasculitis and focal interface dermatitis (Fig. 4). Immunostaining of the skin biopsy failed to show evidence of a lymphoproliferative disorder. Ultimately, the clinical presentation and pathologic analysis of the biopsy specimens appeared most consistent with a paraneoplastic erythroderma.

Bottom Line: The evolution of the dermatitis to erythroderma coincided with the clinical presentation of AML, and was therefore considered to be a paraneoplastic syndrome.The patient decided against therapy and died seven weeks after diagnosis.Physicians should consider a cutaneous paraneoplastic syndrome when faced with dynamic recalcitrant dermatoses that are difficult to treat and decide on laboratory testing accordingly.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

ABSTRACT
Cutaneous paraneoplastic syndromes comprise a broad spectrum of cutaneous reactions to an underlying malignancy. These dermatoses are not the result of metastatic spread to the skin, but rather a reaction to the presence of malignancy. Cutaneous paraneoplastic syndromes often precede the identification of a malignancy. We describe the case of a 79-year-old man with a six-month history of recalcitrant treatment- resistant dermatitis. A complete blood count test performed at the time of initial presentation was normal. The patient ultimately presented with erythroderma and was diagnosed with acute myeloid leukemia (AML). The evolution of the dermatitis to erythroderma coincided with the clinical presentation of AML, and was therefore considered to be a paraneoplastic syndrome. The patient decided against therapy and died seven weeks after diagnosis. Physicians should consider a cutaneous paraneoplastic syndrome when faced with dynamic recalcitrant dermatoses that are difficult to treat and decide on laboratory testing accordingly. Patients should be evaluated regularly for two to three years after initial diagnosis with a physical exam and review of systems to monitor for signs and symptoms of malignancy.

No MeSH data available.


Related in: MedlinePlus