The chilblain-like eruption as a diagnostic clue to the blast crisis of chronic myelocytic leukemia

• Published in: Journal of the American Academy of Dermatology Vol. 50; no. 2; pp. 42 - 44
• Main Authors: Yazawa, Hitoshi, Saga, Kenji, Omori, Fusayuki, Jimbow, Kowichi, Sasagawa, Yutaka
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2004; Elsevier
• Subjects: Aged; Back; Biological and medical sciences; Chilblains - diagnosis; Chilblains - etiology; Chilblains - pathology; Dermatology; Diagnosis, Differential; Erythema - diagnosis; Erythema - etiology; Erythema - pathology; Foot; Hematologic and hematopoietic diseases; Humans; Injuries of the skin. Diseases of the skin due to physical agents; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - complications; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - diagnosis; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Traumas. Diseases due to physical agents; Human; Chilblain; Case study; Myeloproliferative syndrome; Skin disease; Chronic; Dermatology; Chronic myelocytic leukemia; Malignant hemopathy; Diagnosis; Elderly; Crisis
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/S0190-9622(03)02114-5

A 70-year-old Japanese man visited our clinic with the chief complaint of chilblain-like eruptions on the toes of both feet. His toes were bluish, erythematous, and swollen. Neither oral administration of vitamin E for 2 weeks nor wearing insulated socks improved the clinical manifestations. Peripheral blood examination revealed the presence of a large number of monocytic atypical cells and myeloblasts, anemia, and thrombocytopenia. In the bone marrow, monocytic cells were elevated, and myelocytic atypical cells were observed. Chromosomal analysis demonstrated Philadelphia chromosome. We diagnosed him as having a blast crisis of chronic myelocytic leukemia (CML). A biopsy specimen of the skin from the chilblain-like eruption showed infiltration of large, atypical, mononuclear cells; most of them were positive for CD68, and some of them were positive for CD14. Therefore, we concluded that the chilblain-like eruptions on his toes were specific skin lesions of a blast crisis in CML.