Images in Dermatology
Earlobe Infiltration: A Curious Case of Leukemia Cutis
Infiltración en el lóbulo: un caso curioso de cutis leucémico
a Department of Dermatology, Venereology and Leprology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
b Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
c Department of Clinical Haematology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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"apellidos" => "Aboobacker" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Venereology and Leprology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Clinical Haematology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infiltración en el lóbulo: un caso curioso de cutis leucémico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 527 "Ancho" => 867 "Tamanyo" => 97486 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 45-year-old male presented with intermittent fever, loss of weight and appetite for 2 months. On examination he had generalised lymphadenopathy, faint erythematous infiltration of the earlobes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B), and non-palpable, linear purpuras (vibices) involving the trunk and extremities (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Slit skin smears were negative for acid-fast bacilli. Biopsy from right earlobe revealed moderate-dense dermal infiltrate of atypical lymphocytes displaying high nuclear-to-cytoplasmic ratio (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A–C), positive for CD34 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D), CD7 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>E), myeloperoxidase (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>F), TdT (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>G), consistent with leukemia cutis (LC). Blast cells were detected in peripheral smear (18%) and bone marrow aspirate (85%) and immunophenotyping was consistent with early T-cell precursor acute lymphoblastic leukemia (ALL). Extramedullary involvement was absent and he was initiated on adult ALL protocol.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The cutaneous infiltration of leukemic cells in systemic leukemia or LC may manifest as solitary/multiple, localised/disseminated papules, nodules, and plaques, with rare reports of other morphological presentations, often mimicking non-specific skin lesions of leukemia. It is more common among elderly, males, with acute myeloid leukemia or chronic lymphocytic leukemia (CLL).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Earlobe infiltration is an intriguing, localised presentation of LC, previously reported in CLL, but not in ALL.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Biopsy was crucial in excluding other clinical differentials like leprosy, lymphomas, pseudolymphomas, granulomatous rosacea, lupus vulgaris, sarcoidosis, chilblain lupus.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 527 "Ancho" => 867 "Tamanyo" => 97486 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 716 "Ancho" => 1067 "Tamanyo" => 273026 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukemia cutis – epidemiology, clinical presentation, and differential diagnoses: leukemia cutis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Wagner" 1 => "K. Fenchel" 2 => "W. Back" 3 => "A. Schulz" 4 => "M.M. Sachse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1610-0387.2011.07842.x" "Revista" => array:6 [ "tituloSerie" => "JDDG J Dtsch Dermatol Ges" "fecha" => "2012" "volumen" => "10" "paginaInicial" => "27" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115500" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukemia cutis in a patient with chronic lymphocytic leukemia presenting as bilateral helical nodules" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Raufi" 1 => "M. Alsharedi" 2 => "Y. Khelfa" 3 => "D.C. Griswold" 4 => "Y. Lebowicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2050313x16683624" "Revista" => array:3 [ "tituloSerie" => "SAGE Open Med Case Rep" "fecha" => "2016" "volumen" => "4" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011400000004/v1_202304111712/S0001731022008900/v1_202304111712/en/main.assets" "Apartado" => array:4 [ "identificador" => "83194" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imágenes en Dermatología" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000004/v1_202304111712/S0001731022008900/v1_202304111712/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022008900?idApp=UINPBA000044" ]
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