Bullous Sweet syndrome as a presentation of chronic myelogenous leukaemia

Abstract

A woman in her 40s presented with a 3-month-long history of fever and tender erythematous bullous skin lesions not responsive to antibiotics. There had been no previous gastrointestinal, respiratory or urinary infection, nor did she have any history of autoimmune disease, drug reaction or vasculitis.Histological evaluation of skin biopsy showed diffuse dense neutrophilic infiltrates located in dermis diagnostic of Sweet syndrome. Haematological investigations showed leucocytosis with circulating immature cells, which on further investigations with bone marrow biopsy, were evident of chronic myelogenous leukaemia in the accelerated phase. Sweet syndrome was the presenting characteristic of chronic myelogenous leukaemia in this case, which is a rare association. Investigating unusual skin lesions can aid in the suspicion of underlying cancer, allowing for prompt action.

Keywords: Chronic Myeloid Leukemia; Dermatology; Haematology (drugs and medicines); Malignant and Benign haematology.

Figure 1

(A–D) Multiple tender erythematous bullous skin lesions on arms, legs and hands at initial presentation.

Figure 2

(A) Peripheral film showing myeloblasts; (B) peripheral film showing myelocytes and metamyelocytes.

Figure 3

Bone marrow aspirate showing immature myeloid precursors such as blast cells.

Figure 4

(A) Bone marrow trephine showing granulocytic infiltration; (B) bone marrow trephine showing fibrosis.

Figure 5

(A, B) Histopathology slides of the skin biopsy. (A) Ulcerated epidermis with basket-weave keratosis, along with intraepidermal vesicles with marked spongiosis. (B) The underlying dermis exhibits diffuse neutrophilic infiltrate which is extending throughout the whole thickness of the tissue with nuclear debris.