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A Rare Presentation of a Common Malignancy
A 50-year-old female without any comorbidities presented with a history of skin lesions over the face, trunk, and limbs ([Fig. 1]) for 4 months with generalized weakness and weight loss over a period of 2 months. On examination, there were multiple erythematous skin lesions on the face that coalesced to form nodular plaque of varying sizes from 2 mm to 4 cm over the erythematous base with mild scaling and yellowish black crusting. She also had hyperpigmented macules over the trunk and limbs. Other findings were pallor and splenomegaly.
Infections due to immunosuppression: cellulitis, herpes zoster, and herpes simplex
Complete hemogram showed a total leukocyte count of 80,000/mm along with shift to left. Peripheral smear examination showed blasts with increase in myeloid precursors and basophilia. Bone marrow aspirate revealed increased myeloid precursors with the presence of all the stages of maturation (myelocytes, metamyelocytes, and neutrophils). Blasts constituted around 86% of nucleated marrow cells. Karyotyping and fluorescence in situ hybridization showed translocation t(9:22), confirming the diagnosis of chronic myeloid leukemia (CML). Skin biopsy showed diffuse blast cell infiltration in the superficial dermis ([Fig. 2A–D]).
Based on the above investigations, she was diagnosed as a case of CML in blast crisis with leukemia cutis as an extramedullary deposit. CML in blast crisis has a dismal prognosis with a median survival of 9.4 months. Our patient finally succumbed to death after 4 months of presentation. This case emphasizes the fact that a high degree of suspicion and expertise is important for diagnosing such uncommon presentation of common malignancies. Hence, early diagnosis of such rarer presentations helps in appropriate treatment, which ultimately leads to better chance of survival and reduces the risk of fatality.
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18 May 2021 (online)
© 2021. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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