AML (M4) with skin infiltration and Beau’s lines
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2010, Vol 27, Issue 2
Abstract
A 69-year-old woman presented with fatigue, mainly in exercise and an erythematous papular rash, which had appeared on her trunk one month before her admission and increased gradually. Her medical history included hypertension, hyperlipidemia and coronary disease. On admission, her temperature was 36.8 °C and her blood pressure was 150/90 mmHg under amiloride and hydrochlorothiazide treatment in combination with metoprolol tartrate administration. The physical examination revealed pallor and skin lesions, 5–25 mm in diameter that were not painful, tender or pruritic, and were spread over the trunk. Other physical and neurological examinations showed no abnormalities. The respiratory and heart sounds were clear. Laboratory tests indicated anemia, with a hemoglobin level of 9.5 g/dL, leukocyte count of 12.6×109/L (differential count: neutrophils 36%, lymphocytes 40%, monocytes 12%, eosinophils 1% and blasts of monocytic morphology 11%), and thrombocytopenia (88×109/L). Lactate dehydrogenase (715 IU/L) and uric acid (8.1 mg/dL) were increased, while there were no other abnormalities in the biochemical profile of the patients. The bone marrow aspiration showed an infiltration by blasts (55%) that were peroxidase positive. The marrow blasts displayed positive immunophenotyping for CD33, CD13, CD15, CD41a, CD56, CD64, CD68, CD117 and HLA-DR. A skin biopsy was performed which also revealed infiltration in the dermis and subcutaneous fat tissue by leukemic cells that were positive for CD33, CD15, CD45, CD56, CD68 and HLA-DR. Chromosome analysis was normal. Based on the above laboratory and immunophenotypic characteristics the diagnosis was established and the patient started the appropriate therapy. The skin lesions disappeared and became pigmented after two courses of this therapy, and the patient achieved CR. She remained well, with no evidence of relapse nine months after her diagnosis. However, four months post therapy initiation, fine, transverse depressed lines that were parallel and evenly spaced developed on all of her fingernails.
Authors and Affiliations
J. ASIMAKOPOULOS, A. SARANTOPOULOS, T. CHATZILEONIDA, E. PAPAKOSTAS, M. MICHAEL, S. BOUROS, Y. DALAMAGAS, N. VINIOU, K. KONSTANTOPOULOS
Keywords
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