Pedreira-García Wilfredo M, Nieves Dalianie, Montesinos-Cartagena Marlian, Cortés Carlos A, Cáceres-Perkins William, Rabelo-Cartagena José
Internal Medicine, VA (Veterans Affairs) Caribbean Healthcare System, San Juan, PRI.
Hematology and Oncology, San Juan City Hospital, San Juan, PRI.
Cureus. 2022 Dec 27;14(12):e33013. doi: 10.7759/cureus.33013. eCollection 2022 Dec.
Chronic lymphocytic leukemia (CLL) is a malignant proliferation of monoclonal mature B-cells in peripheral blood. Leukemia cells can commonly spread from the blood to other sites such as the lymph nodes, liver, and spleen. However, contrary to T-cell lymphomas that can involve the skin, CLL metastasis to the skin is unusual and is rarely the first manifestation of systemic disease. When leukemia cells invade the skin, it is termed leukemia cutis. Furthermore, multiple skin morphologies can be present in leukemia cutis making diagnosis challenging. Likewise, it can be mistaken for other common etiologies such as drug or substance allergy, infection, and scabies, among others. We herein present a case of CLL with leukemia cutis as the initial manifestation of systemic disease. The initial punch biopsy results were non-specific for inflammatory changes, but a subsequent biopsy revealed findings confirming leukemia cutis. This case not only demonstrates that identifying malignant skin manifestations in a timely manner and treating them is essential, as it improves the quality of life and survival, but also demonstrates that leukemia cutis can be a dynamic disease where multiple biopsies may be needed to confirm the diagnosis, as histopathology can change over time.
慢性淋巴细胞白血病（CLL）是外周血中克隆性成熟B细胞的恶性增殖。白血病细胞通常可从血液扩散至其他部位，如淋巴结、肝脏和脾脏。然而，与可累及皮肤的T细胞淋巴瘤不同，CLL转移至皮肤并不常见，很少作为系统性疾病的首发表现。当白血病细胞侵袭皮肤时，称为皮肤白血病。此外，皮肤白血病可呈现多种皮肤形态，这使得诊断具有挑战性。同样，它可能被误诊为其他常见病因，如药物或物质过敏、感染和疥疮等。我们在此报告一例以皮肤白血病为系统性疾病首发表现的CLL病例。最初的穿刺活检结果显示为非特异性炎症改变，但随后的活检发现证实了皮肤白血病。该病例不仅表明及时识别并治疗恶性皮肤表现至关重要，因为这可提高生活质量和生存率，还表明皮肤白血病可能是一种动态疾病，可能需要多次活检来确诊，因为组织病理学可能随时间变化。
