Leukemia Cutis Presenting as Scrotal Ulcerations in a Patient With Acute Myelogenous Leukemia
Cutaneous manifestations of leukemia can be defined as specific or nonspecific skin lesions. Specific skin lesions include papules, nodules, tumors, or ulcerating plaques caused by the infiltration of leukemic cells (eg, leukemia cutis), while nonspecific skin lesions include petechiae, purpura, ecchymosis, or infection. Leukemia cutis is a rare entity that denotes a poor prognosis. The authors present a case of leukemia cutis with scrotal ulcerations, which heralded the onset of acute myelogenous leukemia. Other causes of painful cutaneous ulcers to consider in a patient with a hematologic malignancy include a variety of infectious and inflammatory etiologies.
The differential diagnosis of painful cutaneous ulcers in the setting of hematologic malignancy includes a variety of infectious and inflammatory etiologies such as ulcerative HSV, cytomegalovirus, Epstein-Barr virus, amoebic skin ulcerations, opportunistic fungal infections, bacterial infections, pyoderma gangrenosum, erythema nodosum, acute febrile neutrophilic dermatosis (Sweet syndrome), histoplasmosis,1 Fournier gangrene, and vasculitis, all of which were ruled out in our case.
We report a case of a patient with a history of essential thrombocytosis who developed leukemia cutis presenting as scrotal ulcerations, which preceded the diagnosis of AML. Ulcerative leukemic lesions on the genitalia are atypical and extremely rare. However, the lesions are notable because they may be suggestive of a poor prognostic outcome, as in our patient whose induction therapy with cytarabine and daunorubicin failed. We propose that leukemia cutis be included in the differential diagnosis of chronic skin ulcerations of the genitalia.
