Atypical leukemia with neuro_dermat manifestation
Yash Talera
Atypical leukemia with neuro_dermat manifestation
29 y/o male with history of autism , seizures and parkinsonism syndrome who present with 5 day history of developing new nodular erythematous lesions in trunk and limbs , fever and headache . history provided by parents .
medications include lamictal , #methylphenidate and sinemet . No recent sick contact . No recent medications . No other significant medical history . Physical examinations revealed crepitations in lower lobes bilaterally and nodules . Vital signs all with in normal limits . pictures are of skin biopsy . CXR reveals bilateral pleural effusions . what is your diagnosis , management plan and prognosis ?
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Y●●h T●●●●a
Y●●h T●●●●a General Medicine
[11/4, 3:38 PM] Yash Talera: Leukemia cutis (LC) is a nonspecific term used for cutaneous manifestations of any type of leukemia. LC has a wide range of cutaneous manifestations, which can make it difficult to clinically distinguish LC from other skin lesions. Patients with LC usually have concomitant systemic leukemia, but occasionally skin involvement precedes the involvement of the bone marrow or peripheral blood. Thus, a skin biopsy can be the first indication of the presence of leukemia in a subset of patients. [11/4, 3:38 PM] Yash Talera: The treatment of leukemia cutis is targeted to the management of the underlying leukemia.Long-term success is best achieved by combination chemotherapy and targeted local therapy of bone marrow, skin and other sites of extramedullary infiltration. In some individuals, total skin electron irradiation has not only been found to be effective in managing leukemia cutis,  but has also been shown to be effective in preventing skin relapse. It has been suggested that aggressive chemotherapy should continue even after remission to prevent further relapse. [11/4, 3:39 PM] Yash Talera: Cutaneous histology usually shows a diffuse infiltration of the dermis and subcutis by leukemic cells, with variable changes between different types of leukemia, and even in different patients with the same type of leukemia . Differentiation from inflammatory skin conditions may be challenging. The diagnosis depends in large part on the recognition of myeloblasts. In most cases, immunohistochemical study is necessary to characterize immunophenotype of tumor cells. Lysozyme is a sensitive marker of myeloid lineage. Detailed examination of the peripheral blood and bone marrow is crucial for the diagnosis of the specific type of leukemia, allowing a correct treatment of these patients. ... Read more
Nov 9, 2016Like