Zelman Brandon, Bode-Omoleye Olaoluwa, Muhlbauer Aaron, Agidi Ada, Mafee Mariam, Velankar Milind, Mirza Kamran, Speiser Jodi, Mudaliar Kumaran
Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA.
Department of Dermatology, Loyola University Medical Center, Maywood, Illinois, USA.
J Cutan Pathol. 2021 Oct;48(10):1277-1281. doi: 10.1111/cup.14030. Epub 2021 Jul 18.
While drug-induced panniculitis is not uncommon in chronic myeloid leukemia (CML) patients on tyrosine kinase inhibitor therapy, it is rare for CML to initially present as a leukemic panniculitis. We present the case of a 45-year-old male with no relevant prior medical history presenting with 6 months of migratory nodules, 2 months of drenching night sweats, and a 20 pound weight loss. Physical examination showed firm subcutaneous nodules with overlying ecchymoses present on the right lateral thigh and left lower back. Biopsy of a nodule from the right thigh showed a subcutaneous lobular panniculitis involved by a dense infiltrate of neutrophils and granulocyte precursors. Fluorescent in-situ hybridization (FISH) was positive for t(9;22)(q34;q11.2)BCR-ABL1 fusion. A concurrent hemogram revealed a white blood cell count elevation of 600,000 K/μL. Bone marrow biopsy examination showed marked myeloid expansion with an increase in granulocyte precursors and Philadelphia chromosome positivity by FISH, consistent with bone marrow involvement by CML. Herein, we describe this unusual and rare case of CML initially presenting as a neutrophilic panniculitis-like leukemia cutis. Arriving at this challenging diagnosis may be easily missed without clinical and laboratory correlation, which would certainly lead to the patient's not receiving life-saving treatment.
虽然药物性脂膜炎在接受酪氨酸激酶抑制剂治疗的慢性髓性白血病（CML）患者中并不少见，但CML最初表现为白血病性脂膜炎却很罕见。我们报告一例45岁男性，既往无相关病史，出现游走性结节6个月、盗汗2个月及体重减轻20磅。体格检查显示右大腿外侧和左下腹有坚实的皮下结节，伴有瘀斑。对右大腿一个结节进行活检，显示皮下小叶性脂膜炎，有密集的中性粒细胞和粒细胞前体浸润。荧光原位杂交（FISH）检测t(9;22)(q34;q11.2)BCR-ABL1融合呈阳性。同时血常规显示白细胞计数升高至600,000 K/μL。骨髓活检显示髓系明显增生，粒细胞前体增加，FISH检测费城染色体阳性，符合CML骨髓受累表现。在此，我们描述了这例CML最初表现为嗜中性脂膜炎样皮肤白血病的不寻常且罕见的病例。如果没有临床和实验室的相关性，很容易漏诊这一具有挑战性的诊断，这肯定会导致患者无法接受挽救生命的治疗。
