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KMID : 0363220150530020175
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Korean Journal of Dermatology
2015 Volume.53 No. 2 p.175 ~ p.177
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Leukemia Cutis in an Infant Presenting as Benign-appearing Exanthema
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Chae Woong-Suk
Seong Jun-Young
Kong Sook-Hyun
Jung Ha-Na
Suh Ho-Seok
Choi Yu-Sung
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Abstract
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Leukemia cutis (LC) refers to the specific infiltration of the skin by neoplastic leukemia cells that occurs mainly in conjunction with systemic leukemia1. The prevalence of thisdisease is 2∼3% in systemic acute leukemia and 10∼15% in acute myeloid leukemia (AML)2. While the mechanisms underlying the migration of the leukemic cells to the skinare not clear, it has been proposed that integrin and other adhesion molecules may play roles in the skin-specific homing behavior of leukemic cells3. We report a case of LC in a 5-month-old infant who presented with asymptomatic erythematous patches on his right lower leg and right cheek that developed 4 weeks after birth. A 5-month-old male patient was referred to the Dermatology Department for the evaluation of coin-sized erythematous patches on the right lower leg and right cheek (Fig. 1). A coin-sized erythematous patch was first detected on the right lower leg 4 weeks after birth. This skin lesionwas persistent and showed no changes in its size and color. Similar lesions developed on the right cheek 4 months after birth. Laboratory tests, which included a complete blood cell count showed no abnormalities, except for a high lactate dehydrogenase level. A histopathological examination showed a diffuse infiltration of leukemic cells into the dermis (Fig. 2A, B). A definitive diagnosis and classification of the leukemia required the immunohistochemical analysis of the skin lesion and correlations with the cytogenetic information. A skin biopsy showed a diffuse infiltration of leukemic cells that were positive for cluster of differentiation(CD) 34, Ki-67, and leukocyte common antigen, and negative for CD3, CD20, myeloperoxidase, and terminal deoxynucleotidyl transferase (Fig. 2C∼I). The bone marrow cytology was consistent with AML of the French-American- British M7 type. The patient had no congenital abnormalities or underlying diseases. The patient was transferred to the Pediatric Department for further evaluation and chemotherapy. Aleukemic LC is a rare condition that is characterized by the infiltration of the skin by leukemic cells before they appear in the peripheral blood or bone marrow4. LC is strongly associated with the leukemic involvement of the bone marrow, peripheral blood, and other extramedullary sites2,3. The diagnosis of aleukemic LC or LC is made with suspicion and is verified by skin biopsies. To make the final diagnosis, hematologic studies are needed as well as the complete analyses of bone marrow aspirates and peripheral blood smears3. Clinically, LC usually presents as single or multiple violaceous, red-brown papules, nodules, and plaques of varying sizes. The legs are most commonly involved, followed by the arms, trunk, and scalp5. The prognosis of LC is directly related to the prognosis of the systemic disease, and myeloid LC has a relatively poor prognosis compared with other types of leukemia2. An atypical clinical presentation makes it difficult for dermatologists to anticipate and diagnose LC in newborns or infants without suspicion. In general, LC with AML has a poor prognosis; hence, early suspicion and confirmation withbiopsies are important.
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KEYWORD
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Acute myeloid leukemia , Leukemia , Leukemia cutis
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