M4 subtype of AML with leukaemia cutis
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2008, Vol 25, Issue 6
Abstract
A 61-year-old man presented with easy fatigue, shortness of breath and headache, particularly with exercise, leg cramps and an erythematous papular rash, which had appeared on the upper extremities three months before his admission and increased gradually in number. He had a family history of secondary acute leukaemia (his mother died because of a secondary leukaemia 19 years after having chemotherapy for Hodgkin’s lymphoma). His medical history included hypertension, and benign prostatic hypertrophy. On admission, his temperature was 36.6 oC and his blood pressure was 146/90 mmHg under amiloride and hydrochlorothiazide treatment in combination with metoprolol tartrate administration. The physical examination revealed skin lesions, 2–7 mm in diameter that were not painful, tender or pruritic, and were spread over the head (fig. 1) and the upper extremities (fig. 2). Other physical and neurological examinations showed no abnormalities. The respiratory and heart sounds were clear. Laboratory tests indicated anaemia, with a haemoglobin level of 9.8 g/dL, leukocyte count of 10.8×109/L (differential count: neutrophils 42%, lymphocytes 37%, monocytes 11%, eosinophils 1% and blasts of monocytic morphology 9%; fig. 3), and thrombocytopenia (62×109/L). Lactate dehydrogenase (628 IU/L) and uric acid (8.4 mg/dL) were increased. C-reactive protein was negative. An electrocardiogram revealed premature ventricular contractions, and bradycardia with complete right bundle branch block. The bone marrow aspiration showed an infiltration by blasts (62%) that were peroxidase positive. The marrow blasts displayed positive immunophenotypes for CD33, CD13, CD34, CD64, CD68, CD117, and HLA-DR. Chromosome analysis revealed normal karyotypes of these cells. The skin biopsy specimen revealed the infiltration of blast cells in the dermis and subcutaneous fat tissue. These cells were identified with the chloracetate esterase stain, and were positive for leukocyte common antigen (CD45), CD33, CD117, and HLA-DR. Based on the above laboratory and immunophenotypic characteristics the diagnosis was established and the patients started the appropriate therapy. The skin lesions disappeared and became pigmented after two courses of this therapy, and the patient achieved CR. He remained well, with no evidence of relapse nine months after his diagnosis.
Authors and Affiliations
S. MASOURIDI, A. SARANTOPOULOS, T. CHATZILEONIGA, E. PAPAKOSTAS, J. ASIMAKOPOULOS, P. KOUZIS, M. ASPRADAKI, N. VINIOU, K. KONSTANTOPOULOS
Keywords
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