Bullous leukemia cutis mimicking facial cellulitis

Abstract

Bullous leukemia cutis is an uncommon clinical manifestation of cutaneous infiltration by leukemic cells, from B-cell chronic lymphocytic leukemia. We present the case of a 67-year-old, female, chronic lymphocytic leukemia patient. She was taking chlorambucil and developed facial edema with erythema and warmth, misjudged as facial cellulitis. Two days later, she developed bullous lesions in the arms, legs, neck and face. The histopathology of facial and bullous lesions confirmed leukemia cutis. All lesions disappeared following the administration of rituximab combined with cycles of fludarabine and cyclophosphamide. Although soft tissue infections are common complications in patients undergoing chemotherapy, leukemia cutis can also resemble cellulitis.

Chimeric antigen receptor-modified T-cell therapy for bone marrow and skin relapse Philadelphia chromosome-like acute lymphoblastic leukemia

“…Control of the cutaneous involvement was essential, considering that LC has been suggested as a marker for aggressive disease and was frequently accompanied by infiltration into other organs such as the liver, spleen, and lymph nodes, which was associated with poor prognosis. [ 14 , 15 , 17 , 18 ] Curative treatment should be directed at eradicating the underlying disease using chemotherapy or HSCT, possibly in the first remission. However, chemotherapy that is adequate to induce and maintain marrow remission does not always control cutaneous involvement.…”

Bullous leukemia cutis: a rare clinical subtype

“…In myeloid leukemias such as AML, the immunophenotypic profile can be positive for CD43, CD33, CD34, and CD117 [2,5,12]. Bullous LC is an unusual variant of LC and therefore difficult to diagnose [6][7][8][9][10]. For example, a reported patient with CLL had her bullous LC misdiagnosed as facial cellulitis [7].…”

“…Bullous LC is an unusual variant of LC and therefore difficult to diagnose [6][7][8][9][10]. For example, a reported patient with CLL had her bullous LC misdiagnosed as facial cellulitis [7]. Review of the available retrospective studies of patients with LC reflect the rarity of the bullous clinical subtype.…”

Unilateral facial actinic elastotic plaque: A distinct but underreported manifestation of solar elastosis

“…4 A more chronic course prompts the exclusion of a tumoral process. 3 Both benignant 3 and primary 5 or metastatic malignant neoplasias 6 can manifest as unilateral malar enlargement. The oncologic history of the first case reinforced the latter possibility.…”