Table of Contents

HK J Paediatr (New Series)
Vol 2. No. 2, 1997

HK J Paediatr (New Series) 1997;2:183

Proceedings of Scientific Meeting

Cutaneous Manifestation of Four Children with Myeloid Malignancies as Presenting Symptom

KW Chik, TF Leung, P Choi, KF To, MMK Shing, CK Li, PMP Yuen

HK J Paediatr (new series) 1997;2:175-186

Hong Kong Paediatric Society 35th Anniversary Scientific Meeting September 6,1997

We reviewed four patients with myeloid malignancies presenting with cutaneous dermatoses as the earliest feature. They all have resistant skin conditions months (range: 2 - 9 months) before the diagnosis of leukaemia. All except the first patient had skin biopsy performed. The clinical manifestation is tabulated below:

Patient Sex/Age of no. Presenting skin diagnosis Diagnosis manifestation
1 M/10/12 Papular skin rash of 0.5 cm in size over whole body for 5 months Monosomy 7, Juvenile chronic myeloid leukaemia
2 M/95/12 Itchy urticarial skin rash with pigmentation over lower limbs and abdomen for 9 months Monosomy 7, Chronic myelomonocytic leukaemia Neurofibromafosis type I
3 F/611/12 Itchy erythematous papular rash starting from lower limb spreading up to involve the whole body, excoriation present, 2 months before diagnosis Myelodysplastic syndrome, refractory anaemia with excessive blasts in transformation
4 F/105/12 Itchy plaque like skin lesion above ankle bilaterally with hairy growth for 7 months before diagnosis Acute myeloid leukaemia, M2

These skin lesions were indeed red herring. They appeared like eczema, chronic urticaria, psoriasis and fungal infection. Skin biopsies performed were not conclusive of malignancy. They demonstrated perivascular mixed inflammatory cells infiltrate with dermatitis like features in the second and third patient. Myeloid cell infiltration was present for patient no 4. The response to the usual treatment was partial. Regression of these skin condition was noted after instituting chemotherapy.

In conclusion, the presenting feature of myeloid malignancy can be protean and nonspecific. Children with atypical skin lesion should be examined systematically and followed up regularly for unusual diseases.


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