Bullous pyoderma as a presentation of acute leukaemia

Abstract

A patient with an unusual bullous pyoderma preceding the onset of acute leukaemia is reported. The initial lesions were purplish bullae, which later formed superficial ulcers and healed with minimal scarring. Histology showed intra-epidermal bullae with a dense polymorphonuclear infiltrate in the epidermis. This eruption is difficult to classify, but fifteen patients with similar skin lesions have been found in the literature, seven of these patients developed acute leukaemia and one had metastatic adenocarcinoma on presentation. We feel that the recognition of these distinctive skin lesions may be important because of their association with internal malignancy.Skin lesions in acute myeloid leukaemia usually occur at the height of the disease and are due to infection, or infiltration by leukaemic cells.This report describes a patient who presented with unusual bullous skin lesions. She subsequently developed acute myelomonocytic leukaemia and her skin lesions proved to be due neither to infection nor leukaemic infiltration. Case reportA 32-year-old woman presented on 5 May 1975, with a 9-day history of painless purulent lesions on her chin, and 4-day history of general malaise. She had been treated without efFeet with topical Fucidin and oral penicillin by her General Practitioner.

Sweet’s Syndrome with Myelofibrosis and Leukemia: Partial Response to Interferon

“…These neutrophilic dermatoses are pail of the same spectrum, often without fever or neu trophilia, hence the unifying name AND -as the histologic pattern in these patients consistently displays an extensive diffuse dermal infiltrate of neutrophils often with leukocytoclasia 11,3], There have been over 60 patients reported with AND and myeloproliferative disease [6, 13-16, 22, 23]; the latter was usually detected months after the onset of the skin changes, although in some patients they were detected simultaneously [2,22]; a few patients with AND have been first observed after the malignant diagnosis was established. The course of the skin lesions has been noted to parallel the leukemia, with the original observation of the rapid demise of the patient occurring in most cases so far reported, usually from myelogenous leukemia [19,24], AND has also been reported in association with myeloma, T-cell lymphoma, histiocytic lymphoma and over 40 solid tumors [1, 2, 13-15, 24-27], These solid tumors include carci noma of the ovary, testes, breast, uterus, stomach, vagina, colon, prostate, rectum, kidney and thyroid [13-15, 25, 27], Extracutaneous manifestations of Sweet's syndrome are varied. Beside the fever and neutrophilia, which may or may not be present, there may be a nondeforming asymme tric large joint arthritis, coinjunctivitis, episcleritis, mesangiocapillary glomerulonephritis, hepatitis and pulmonitis [2,14,25].…”

“…The resemblance of so-called atypical or bullous pyoderma gangraenosum to Sweet's syndrome [17][18][19][20] was noted in the discussion by Pegum [21J after presentation of a patient labeled as having 'bullous pyoderma gangraenosum' and chronic myeloid leukemia. These neutrophilic dermatoses are pail of the same spectrum, often without fever or neu trophilia, hence the unifying name AND -as the histologic pattern in these patients consistently displays an extensive diffuse dermal infiltrate of neutrophils often with leukocytoclasia 11,3], There have been over 60 patients reported with AND and myeloproliferative disease [6, 13-16, 22, 23]; the latter was usually detected months after the onset of the skin changes, although in some patients they were detected simultaneously [2,22]; a few patients with AND have been first observed after the malignant diagnosis was established.…”

Pyoderma gangrenosum as an Early Revelator of Acute Leukemia

“…In bullous pyoderma gangrenosum, a dense band-like neutrophilic infiltrate is seen in the dermis [2,6]. The etiopathogenesis of the disorder remains unclear.…”

Pulse therapy. Therapeutic efficacy in the treatment of pyoderma gangrenosum

“…Healing produces an atrophie scar with a distinctive cribriform appearance. Multiple diseases are associated with pyoderma gangreno¬ sum, including inflammatory bowel disease,711 arthri¬ tis,4,712"14 dysproteinemia,1518 and leukemia.19 24 Fifty percent of our patients, after exhaustive examinations, have shown no associated systemic illness. 5 Pyoderma gangrenosum represents a clinical model of corticosteroid-responsive inflammatory skin disease that is well suited to the study of the efficacy of pulse therapy.…”