Cutaneous manifestation of chronic lymphocytic leukemia: a case report and a literature review

B-cell chronic lymphocytic leukemia (CLL) is the most prevalent type of leukemia among people aged 65 and more [1]. It usually develops in a predictable way, initially manifesting itself in peripheral blood and subsequently entering also extramedullary locations: the lymph nodes, the spleen, and the liver, described in detail by Rai et al., and became the foundation of the classical prognostic system [2]. Various skin lesions are relatively frequent among people suffering from CLL but a real lesion of the skin by leukemic cells called leukemia cutis (LC) is a rare manifestation and may be associated with a more aggressive course of the disease [3, 4].
In this paper we present a patient with a histopathologically confirmed case of infiltration of the skin by chronic lymphocytic leukemia lymphocytes. The occurrence of skin lesions correlated with the disease’s progression. In the case report we both refer to the results of the treatment and present the literature pertaining to the topic introduced above.
Course of the disease: In 2014, a 68-year-old man went through a routine check-up which showed an elevated lymphocyte count in peripheral blood. At that time, the patient showed no general symptoms, such as night sweats, raised temperature or loss of weight. Physical examination did not show enlarged lymph nodes, liver or spleen. Laboratory tests established the white blood cell count of 26.80 G/l, haemoglobin concentration of 15.6 g/dl and platelet count of 220 G/l, small lymphocytes were dominant in the blood smear. Between 2014 and 2017 the patient remained under observation without getting any treatment.
In March 2017, the patient observed a single skin lesion on his lower abdomen, accompanied by redness and mild itching. About a month later, he noticed increased night sweating, without fever or loss of weight. Physical examination showed enlarged lymph nodes and spleen (ca. 2 cm below the left rib arch) but no palpable enlargement of the liver. In the following weeks, there was a progression of the skin lesions in the form of numerous red and blue-purple lumps and bumps on the skin on the patient’s arms, back, lower abdomen and thighs (Figure 1). At that time, laboratory tests showed an elevated white blood cell count of 142.61 G/l, haemoglobin concentration was 14.3 g/dl while platelet count was 167 G/l. The blood smear showed 92% of small lymphocytes, typical of the classical form of chronic lymphocytic leukemia....


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