Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction:
Acute myeloid leukemia (AML) is a clonal proliferation of immature myeloid precursors called myeloblasts. Common presenting symptoms include recurrent infections, fatigue, fever, anemia, and bruising. AML primarily affects older adults with a worse prognosis due to advanced age. Leukemia cutis is a rare extramedullary manifestation caused by dermal infiltration of leukemic cells. These cutaneous lesions may mimic benign dermatologic conditions and thus delay diagnosis. This case highlights the clinical course, diagnosis, and outcomes of AML presenting as leukemia cutis, providing invaluable insights for clinicians in the primary care setting to have a high index of suspicion of malignancy and to never hesitate to biopsy.
Case Presentation:
An 81-year-old male with a past medical history significant for prostate cancer s/p radical prostatectomy, restless leg syndrome, and GERD presented to the clinic complaining of bee stings to his face, neck, back, and head onset 2 weeks ago. At home remedies included lemon juice, salt, and ground aspirin with no alleviation of symptoms. On a physical exam, firm and non-pruritic nodules palpated in various locations as stated by the patient. The patient was initially treated for presumed insect bites/infection, however due to a high index of suspicion for malignancy a punch biopsy was scheduled. The patient followed up for a 6 mm punch biopsy with subsequent presentation to the emergency department with bruising on his arms and lower extremities associated with fatigue, chills, and vague chest pain. Upon arrival, initial EKG noted for sinus rhythm with rate of 67 bpm and no signs of STEMI and chest x-ray with no acute cardiopulmonary findings. Initial lab results showed leukocytosis (WBC 24.5), hemoglobin of 12.5, thrombocytopenia (platelet count 15), BUN of 36, and creatinine of 1.7. Due to concerns of acute kidney injury, gentle intravenous hydration was initiated. Oncology promptly consulted due to concerns of the presence of chloromas and a punch biopsy report still pending. Flow cytometry ordered and revealed granulocytopenia with 83% immature monocytes. Bone marrow biopsy performed with 88.9% monocytes. Patient diagnosed with acute myeloid leukemia with monocytic differentiation. The patient was informed of the aggressive nature of this disease and its poor prognosis. He was immediately started on Vidaza, a DNA methyltransferase inhibitor, and delayed initiation of venetoclax, a BCL-2 inhibitor. The patient developed refractory leukemia and expired.
Conclusion:
This case presents AML in its rare extramedullary manifestation as leukemia cutis and reveals that without a high index of suspicion for malignancy, can mimic benign dermatologic conditions. Once AML is diagnosed, the patient needs an interdisciplinary team composed of a primary care physician, oncologist, hematologist, pharmacist, and nurses to achieve optimal treatment outcomes. It is vital to always have a high index of suspicion for malignancy and to rule it out. Primary care physicians are often the first point of contact for patients and play a vital role in facilitating early diagnosis and timely treatment in cases of malignancy. Being vigilant and cognizant of atypical presentations of leukemia, such as in the case of this patient with AML, physicians can save patients from unnecessary suffering due to lack of treatment.
Embargo Period
5-27-2026
An Atypical Presentation of Acute Myeloid Leukemia (AML)
Moultrie, GA
Introduction:
Acute myeloid leukemia (AML) is a clonal proliferation of immature myeloid precursors called myeloblasts. Common presenting symptoms include recurrent infections, fatigue, fever, anemia, and bruising. AML primarily affects older adults with a worse prognosis due to advanced age. Leukemia cutis is a rare extramedullary manifestation caused by dermal infiltration of leukemic cells. These cutaneous lesions may mimic benign dermatologic conditions and thus delay diagnosis. This case highlights the clinical course, diagnosis, and outcomes of AML presenting as leukemia cutis, providing invaluable insights for clinicians in the primary care setting to have a high index of suspicion of malignancy and to never hesitate to biopsy.
Case Presentation:
An 81-year-old male with a past medical history significant for prostate cancer s/p radical prostatectomy, restless leg syndrome, and GERD presented to the clinic complaining of bee stings to his face, neck, back, and head onset 2 weeks ago. At home remedies included lemon juice, salt, and ground aspirin with no alleviation of symptoms. On a physical exam, firm and non-pruritic nodules palpated in various locations as stated by the patient. The patient was initially treated for presumed insect bites/infection, however due to a high index of suspicion for malignancy a punch biopsy was scheduled. The patient followed up for a 6 mm punch biopsy with subsequent presentation to the emergency department with bruising on his arms and lower extremities associated with fatigue, chills, and vague chest pain. Upon arrival, initial EKG noted for sinus rhythm with rate of 67 bpm and no signs of STEMI and chest x-ray with no acute cardiopulmonary findings. Initial lab results showed leukocytosis (WBC 24.5), hemoglobin of 12.5, thrombocytopenia (platelet count 15), BUN of 36, and creatinine of 1.7. Due to concerns of acute kidney injury, gentle intravenous hydration was initiated. Oncology promptly consulted due to concerns of the presence of chloromas and a punch biopsy report still pending. Flow cytometry ordered and revealed granulocytopenia with 83% immature monocytes. Bone marrow biopsy performed with 88.9% monocytes. Patient diagnosed with acute myeloid leukemia with monocytic differentiation. The patient was informed of the aggressive nature of this disease and its poor prognosis. He was immediately started on Vidaza, a DNA methyltransferase inhibitor, and delayed initiation of venetoclax, a BCL-2 inhibitor. The patient developed refractory leukemia and expired.
Conclusion:
This case presents AML in its rare extramedullary manifestation as leukemia cutis and reveals that without a high index of suspicion for malignancy, can mimic benign dermatologic conditions. Once AML is diagnosed, the patient needs an interdisciplinary team composed of a primary care physician, oncologist, hematologist, pharmacist, and nurses to achieve optimal treatment outcomes. It is vital to always have a high index of suspicion for malignancy and to rule it out. Primary care physicians are often the first point of contact for patients and play a vital role in facilitating early diagnosis and timely treatment in cases of malignancy. Being vigilant and cognizant of atypical presentations of leukemia, such as in the case of this patient with AML, physicians can save patients from unnecessary suffering due to lack of treatment.