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Cutaneous Vasculitis as the Initial Manifestation in Acute Myelomonocytic Leukemia

Konstantinos Bourantas, MD; Vasiliki D. Malamou-Mitsi, MD; Leonidas Christou, MD; Spiridoula Filippidou, RN; and Alexandros A. Drosos, MD
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From the School of Medicine, University of Ioannina, Ioannina, Greece. Requests for Reprints: Alexandros A. Drosos, MD, Assistant Professor of Rheumatology, Department of Internal Medicine, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;121(12):942-944. doi:10.7326/0003-4819-121-12-199412150-00006
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Vasculitides are a heterogeneous group of clinical disorders that are idiopathic (polyarteritis nodosa, Wegener granulomatosis) and that may be associated with connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, scleroderma); with sepsis; or with neoplasia [12], especially leukemias and lymphomas [311]. In vasculitides, the basic histopathologic characteristic is inflammatory changes in vessel walls. The inflammatory infiltrate can be predominantly neutrophilic (usually accompanied by leukocytoclasis), lymphocytic, or granulomatous. Necrotizing changes (usually of fibrinoid type) of the vessel wall may be present or absent. Acute myelomonocytic leukemia is a neoplastic disorder of the granulocytic and monocytic lineage that is characterized by a mixture of immature cells, mainly myeloblasts and monoblasts in the peripheral blood and bone marrow. Patients with acute myelomonocytic leukemia may present with extramedullary neoplastic infiltrates in the liver, gingiva, skin, and central nervous system. Skin involvement in acute myelomonocytic leukemia includes three types of lesions: nonspecific, leukemic cutis, and granulocytic sarcoma [1213].

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Figure 1.
Skin lesions of leukocytoclastic vasculitis affecting the legs of patient 1.
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Figure 2.
Skin biopsy specimen from patient 1.arrow heads

Shows a moderately dense, vascular inflammatory infiltrate ( ) of the dermis. (Periodic acid stain; original magnification, × 330.).

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