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The Skin Lesions of Monocytic Leukaemia

1947; Springer Nature; Volume: 1; Issue: 4 Linguagem: Inglês

10.1038/bjc.1947.32

1532-1827

E A Fairburn, A. S. V. Burgen,

Chronic Lymphocytic Leukemia Research

SrNcE 1913, when Reschad andSchilling-Torgau (1913) first distinguished monocytic leukaemia from the lymphatic and myelogenous types, over 250 cases have been reported (Evans, 1942).In their case report Reschad and Schilling- Torgau noted widely distributed nodules in the skin, which, histologically, were packed full of cells similar to those present in the peripheral blood.In most instances subsequent observers have focused their attention on the interesting haematology of the disease, whilst little attention has been paid to the relatively, common and often distinctive cutaneous lesions.In lymphatic and myelogenous leukaemias petechiae in the skin are fairly common.They usually occur in the later stages of the disease, and are indis- tinguishable from petechiae of other origin.Specific cutaneous changes are rare.In monocytic leukaemia, on the other hand, non-purpuric skin lesions were reported in 36 per cent of patients by Isaacs and Sturgis (1936) and in 10 per cent by Freeman and Koletsky (1939), while of 6 cases of the disease admitted to the Middlesex Hospital in the past 10 years, 2 developed non-purpuric rashes.Further, the purpura of monocytic leukaemia did not always remnain petechial.In many reported cases it became raised and infiltrative, and progressed to fully developed nodular or ulcerative lesions.It would appear that the presence of such rashes should rank in diagnostic importance with ulcerative hypertrophic gingivitis.Especially interesting are the rare cases, such as the one reported below, in which a " disseminated furunculosis " or other cutaneous lesion preceded the onset of a leukaemic haematology.The possi- bility then arises that the leukaemic process has originated in the reticulo-endo- thelial cells of the skin, and has only later involved locations more intimately concerned with haemopoiesis.Case Report.M. F--, male, aged 20.In June, 1945, the patient first suffered an attack of furunculosis involving mainly the shoulders and neck.This gradually sub- sided during a 6-weeks' stay in hospital.In September, 1945, he joined the Royal Artillery as a gunner, and soon after enlistment had another attack of boils on his back, and to a lesser extent on the neck and face.As before, the lesions gradually healed during a further 8 weeks' hospitalization.In November, 1945, he was drafted to India, where he was stationed at Madras, and later at Bangalore.A few weeks after his arrival in India crops of boils began to appear once more on the shoulders, neck and face.By February, 1946, nodules had developed on the right arm.These never became pustular, but progressed to a brawny thickening, and later formed shallow ulcers.At this time he had a remittent pyrexia and his spleen was observed to be palpable.A swab taken from the * Survival time was taken from the first appearance of clinical symptoms or signs. 36()