Rare Skin Rash In CLL Patient is AML

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Concurrent chronic lymphocytic leukemia cutis and

acute myelogenous leukemia cutis in a patient with

untreated cll.

MK, et. al.

Mount Sinai School of Medicine, New York, New York.

Patients who have chronic lymphocytic leukemia (CLL)

are known to have a high frequency of second malignant

neoplasms. However, acute myelogenous leukemia (AML)

occurring concurrent with or after a diagnosis of CLL

is extremely rare.

In this article we report a case of AML developing in

a 55-year-old male with a 6-year history of untreated

CLL. The diagnosis was facilitated by touch

preparation of a skin punch biopsy specimen. The

patient presented with a two-week history of fever,

weakness, anasarca (generalized edema with

accumulation of serum in connective tissue), and a

skin rash.

Physical examination revealed pink to skin-colored

firm papules, which coalesced into indurated (firm or

hard) plaques on his trunk, upper extremities, and

face. The lesions, in combination with generalized

edema, produced a leonine facies (thick, nodulous

lion-like skin). Touch prep of the biopsy showed

medium to large blasts, large monocytoid cells, and

numerous small mature lymphocytes, providing the

preliminary diagnosis of a second, previously

undiagnosed myelomonocytic malignancy in this patient.

The initial diagnosis was subsequently confirmed by

histologic, cytochemical, immunohistochemical and flow

cytometry studies. This is the first reported case of

CLL with concurrent AML in which rapid touch prep of a

skin punch biopsy facilitated diagnosis.

PMID: 11481527 [PubMed - in process]

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