A 78-year-old female was admitted with respiratory distress and nodular erythematous to violaceous lesions on her face.

A 78-year-old woman with history of acute myeloid leukemia (AML-M4) since 5 months ago was admitted with diffuse skin infiltration and dyspnea. Physical examination showed tachycardia, tachypnea, nodular erythematous to violaceous lesions on her face [Figures 1 and 2], trunk and abdomen [Figure 3], and bilateral respiratory rales. Electrocardiogram (ECG) showed sinus tachycardia. Laboratory findings included the following: White blood cell count (WBC) = 133,300/μL (myeloblast = 46%, monoblast = 34%, neutrophil = 15%, lymphocyte = 5%), Hb = 8.9 gr/dl, and platelet count = 62,000/μl. The patient died due to respiratory failure.

Figure 1

Skin lesions on her face

Figure 2

Skin lesions on her face from lateral view

Figure 3

Skin lesions on her abdomen

Question

What is your diagnosis for Figures 1-3?

Answer

Leukemia Cutis.

The diagnosis of leukemia cutis and respiratory distress due to leukostasis was made.

Leukemia cutis is infiltration of leukemic cells in epidermis, dermis, and subcutis. The majority of cases are seen in AML especially in AML-M4 and -M5 subtypes.[1-3] In this 78-year-old female with AML-M4, we saw diffuse skin involvement by leukemic cells that leaded to a bizarre appearance in her face.