Hypersensitivity Reaction as a Harbinger of Acute Myeloid Leukemia: A Case Report and Review of the Literature

Abstract

Cutaneous paraneoplastic syndromes comprise a broadspectrum of cutaneous reactions to an underlying malignancy. These dermatoses are not the result of metastatic spread tothe skin, but rather a reaction to the presence of malignancy. Cutaneous paraneoplastic syndromes often precede theidentification of a malignancy. We describe the case of a79-year-old man with a six-month history of recalcitrant treatment-resistant dermatitis. A complete blood count test performedat the time of initial presentation was normal. The patientultimately presented with erythroderma and was diagnosedwith acute myeloid leukemia (AML). The evolution ofthe dermatitis to erythroderma coincided with the clinicalpresentation of AML, and was therefore considered to be aparaneoplastic syndrome. The patient decided against therapyand died seven weeks after diagnosis. Physicians shouldconsider a cutaneous paraneoplastic syndrome when facedwith dynamic recalcitrant dermatoses that are difficult totreat and decide on laboratory testing accordingly. Patientsshould be evaluated regularly for two to three years after initialdiagnosis with a physical exam and review of systems tomonitor for signs and symptoms of malignancy.