Abstract Ref Number = APCP904
LEUKEMIA CUTIS IN A 12-YEAR-OLD BOY WITH ACUTE MYELOBLASTIC LEUKEMIA AND SEVERE MALNUTRITION
Novita Assa,Ketut Ariawati
RSUP Sanglah Denpasar Bali Department of Child Health, Medical School of Udayana University, Sanglah Hospital, Denpasar, Bali, Indonesia
Background : Leukemia is a malignant neoplasm affecting the hematopoietic system. Incidence averages 4-4.5 cases/year/100.000 in children younger than 15 years. Following a generalization phase in the bone marrow and subsequent appearance of leukemic cells in the peripheral blood, extramedullary manifestation can occur in various organs of the body, including the skin. Leukemia cutis is an aggressive leukemia cell infiltration into the epidermal, dermis, and sub-cutis layers. The incidence is very rare, can occur in all types of leukemia.
Case Presentation Summary : A 12-year-old boy, referred to Sanglah Hospital with with pale, intermittent fevers, gum bleeding since 10 month and lumps on the skin since 2 months before hospital admission. Physical examination was showed gingival hyperplasia, multiples mass of 1-3 cm in diameter in the head, neck, thoracic, abdominal and hand region, hepatomegaly and splenomegaly. The nutritional status was severe malnutrition. Laboratory examinations showed leukocytosis, mild anemia, and severe thrombocytopenia. Bone marrow aspiration occurs AML suspicion with 10% myeloblast, and 5% monoblast. Skin biopsy suggests cutaneous infiltration by myeloblast and monoblast. We diagnosed the patient with acute myeloblastic leukemia, leukositosis, cutis leukemia, and severe malnutrition. Patient got hydration intravenously in order to prevent leukostasis syndrome. We planned a chemotherapy guided by non-lymphoblastic acute leukemia protocol. After 4 months of chemotherapy patients and families decided not to continue chemotherapy and only supportive therapy such as transfusions. The patient passed away 9 months after the diagnosis.
Learning Points/Discussion : Leukemia cutis is uncommon as the presenting feature of AML and is associated with an unfavorable prognosis. There is no specific treatment for the cutaneous leukemia other than palliation and symptomatic relief. The 2-year survival rate for the unfavorable prognostic group it is 10-20%.
Keywords: leukemia cutis myeloblastic leukemia malnutrition children