Celiac disease is an immune-mediated disorder triggered by dietary gluten. It classically presents with gastrointestinal symptoms. It may also present with atypical manifestations like anemia, arthritis, infertility, or other neurological symptoms. However, arthralgia as a sole manifestation of celiac disease is a rare clinical scenario. Even though the clinical spectrum of celiac disease is broad, prompt diagnosis and management exert a protective effect against complications of celiac disease. We want to highlight and expand on the existing knowledge on atypical presentations about celiac disease.
Leukemia cutis (LC) is a manifestation of leukemia with infiltration of the dermis, epidermis, or subcutis by malignant leukocytes resulting in papules, plaques, nodules, or ulcers. It is usually associated with acute and chronic myeloid leukemia as well as T-cell acute lymphoblastic leukemia (T-ALL) but is very rare in patients with B-cell acute lymphoblastic leukemia (B-ALL). We report a case of a 58-year-old Hispanic male who presented with a non-healing leg ulcer of three months along with patches on the face, left arm, and bilateral legs with white blood cell (WBC) count of 50800/mm 3 with 83% blasts, and flow cytometry findings of BALL. Punch biopsies from affected skin showed numerous dermal nodules composed of large atypical cells with open chromatin and prominent nucleoli. Immunohistochemical stains were consistent with BALL involving the skin and a diagnosis of LC was rendered. A high index of suspicion in relevant cases and prompt diagnosis is imperative to prevent any delays in appropriate therapy. Diagnosis in our case was aided by concurrent identification of BALL in the patient's peripheral blood. Since this information may not always be available, it is important to keep BALL in the differential any time there is a neoplastic infiltration of leukocytes in the dermis.
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