CASE PRESENTATION
A 76-year-old man with no significant past medical history presented to
our clinic with a six months skin hyperpigmentation and fatigue. The
patient was treated with skin-lightening and antisolar creams but with
no improvement. Clinical examination showed brown to violet
hyperpigmented patches on face and upper trunk. Mucosal examination
showed -violaceous plaques on the upper palate in addition to yellow
sclera with red to purple patches on the inner aspect of both lower
eyelids (figure 1). Physical examination showed lymphadenopathy
especially in axillary area. Laboratory evaluations revealed white blood
cell 4.6 × 10 3 /L with neutrophil and lymphocyte
differentiation (18% and 50%, respectively), hemoglobin 10.5 g/dl and
platelet count of 72 × 10 3 μl.
Two skin biopsies from face and chest were taken with differential
diagnoses of angiosracoma, lymphoma, and lichen planus. The result
showed dense dermal multinodular perivascular and periadnexal
infiltration with atypical mononucleated cells with IHC evidence
consistent with leukemic dermal infiltration (figure 2).
Immunohistochemistry (IHC) staining was carried out according to
morphological findings and showed infiltrated cells with irregular
indented nuclei and high nuclear/cytoplasmic ratio which was positive
for leukocyte common antigen (LCA). No CD20, CD79a, CD3, CD45, CD30, MPO
or CD68 were detected in infiltrated cells. Clinical and
histopathological findings in addition to the flow cytometric
immunophenotyping of peripheral blood were compatible with myeloid
leukemia m5.