Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP910

Poster Presentation

CASE REPORT DIAGNOSTIC PITFALLS IN ACUTE LEUKEMIA PRESENTING AS CUTANEOUS LESSION IN CHILDREN

Fatimatuzzuhroh Wicaksono,Ludi Dhyani Rahmartani Depatment of Child Health Fakulty of Medicine Universitas Indonesia Cipto Mangunkusumo National General Hospital Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National General Hospital

Background : Cutaneous lesion is one of the first sign of the haematological malignancy in patient with leukemia cutis (LC), as results of the infiltration of neoplastic leukocytes or their precursors into the epidermis, the dermis, or the subcutis. LC can present in the setting of acute myeloid leukemia. Recognition of LC is important for early diagnosis and further classification, but the diagnosis is difficult in the earlier course of the disease because of the absence of a systemic presentation of acute leukemia. Case Presentation Summary : A 3 year old asian male presented with a rash on his face for 3 weeks, rapidly spreading within the first one week of the course of the disease. The rash, which consisted of multiple erythematous papulonodular plaque, spreaded on the head, neck, trunk and extremity. He was treated several times for drug allergies in previous multiple clinics. He was referred to our centre because the rash were getting worse. His eyes and gingiva were swollen hence he could not close his eyes and his mouth. Laboratory findings shows anemia (Hb 6,74 g/dL), hiperleucocytosis (leucocyte 191.000/uL) and thrombocytopenia (thrombocyte 69.200/uL). Blast cells were found in the blood smear (44%). A bone marrow puncture and immunophenotyping were performed and showed acute myeloblastic leukemia type M5b with myeloblast cells dominating in bone marrow smear (+ 70%). He was diagnosed as AML type M5b with hyperleucocytosis and treated with hidration and alkalinization followed by escalation dose of cytarabine and chemotherapy. The respons therapy was promising, the cutaneous lesion was improving, his swollen eyes and gingiva were recovering, and his leucocyte count back to normal with no blast cells found in the blood smear. Learning Points/Discussion : Patient presented with uncommon form of cutaneous lesion should be evaluated for other causes and need thorough examination for diagnosis, in order to give prompt and appropriate treatment.

Keywords: leukemia kutis acute myeloid leukemia diagnostic pitfalls uncommon cutaneous lession