Martins Miguel, Barbosa Joana, Eusébio Sofia P, Prayce Rita, Pires Pedro
Internal Medicine, Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT.
Dermatology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT.
Cureus. 2023 Jan 6;15(1):e33456. doi: 10.7759/cureus.33456. eCollection 2023 Jan.
We report the case of a man in his 50s with refractory acute myelomonocytic leukaemia (AML) who presented with neck swelling, fever, and elevated levels of C-reactive protein (CPR) after venous punctures. An infected haematoma was presumed, but the patient showed no signs of improvement under broad-range antibiotics, and microbiological results were negative. The subsequent development of a rapidly evolving erythematous-violaceous plaque around a site that had previously punctured on the extensor surface of the right arm prompted us to reconsider the clinical setting as a whole and consider the hypothesis of deep neutrophilic dermatosis (ND) associated with haematologic malignancy. A biopsy of the arm lesion showed an aseptic neutrophilic infiltrate, confirming this diagnosis. The patient was initially treated with high-dose intravenous corticosteroids, resulting in a dramatic improvement of the skin lesions.
我们报告了一例50多岁患有难治性急性粒单核细胞白血病(AML)的男性病例,该患者在静脉穿刺后出现颈部肿胀、发热和C反应蛋白(CRP)水平升高。推测为感染性血肿,但患者在使用广谱抗生素治疗下未见改善迹象,微生物学检查结果为阴性。随后,在右臂伸侧先前穿刺部位周围迅速出现一个不断演变的红斑紫罗兰色斑块,促使我们重新审视整个临床情况,并考虑与血液系统恶性肿瘤相关的深部嗜中性皮病(ND)这一假说。对手臂病变进行活检显示为无菌性嗜中性粒细胞浸润,从而证实了这一诊断。患者最初接受大剂量静脉注射皮质类固醇治疗,皮肤病变得到显著改善。