Leukocytoclastic vasculitis as a previously unreported paraneoplastic manifestation of acute lymphoblastic leukemia in a
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CASE REPORT
Leukocytoclastic vasculitis as a previously unreported paraneoplastic manifestation of acute lymphoblastic leukemia in adults Rashad Ismayilov 1
&
Tahmaz Haziyev 2
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Deniz Ates Ozdemir 3
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Arzu Saglam 3
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Yahya Buyukasik 2
Received: 4 September 2020 / Accepted: 22 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Although leukocytoclastic vasculitis (LCV) is often idiopathic or secondary to benign diseases, it sometimes accompanies malignancies. Besides being more common in hematological cancers compared to solid tumors, the association of acute lymphoblastic leukemia (ALL) with LCV is extremely rare. Case report In this study, we present a 22-year-old woman presenting with palpable petechiae, purpura, and ecchymoses on her limbs. Bone marrow and skin biopsy of the patient with bicytopenia revealed precursor B cell ALL and LCV, respectively. Conclusion This case is the first adult ALL case with paraneoplastic LCV. In this study, it is emphasized that hematological malignancies should be considered in patients presenting with cutaneous vasculitis, especially in the presence of cytopenia. Keywords ALL . Leukocytoclastic vasculitis . Cutaneous vasculitis . Paraneoplastic syndrome
Introduction Leukocytoclastic vasculitis (LCV) is a histopathological definition and is characterized by inflammation in small vessels of the skin and the breakdown of neutrophils [1]. Cutaneous vasculitis can present in different ways: (a) as cutaneous component of systemic vasculitis, (b) as skin-limited or skin* Rashad Ismayilov [email protected] Tahmaz Haziyev [email protected] Deniz Ates Ozdemir [email protected] Arzu Saglam [email protected] Yahya Buyukasik [email protected] 1
Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
2
Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
3
Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
dominant variant of systemic vasculitis, and (c) as single organ vasculitis of the skin [2]. Although single-organ vasculitis of the skin is more often idiopathic, it can also develop secondary to many causes such as drugs, infections, connective tissue diseases, and malignancies. Paraneoplastic cutaneous vasculitis occurs at a rate of 3.8% and is more common in hematological malignancies than in solid tumors [3]. To our knowledge, the patient we present is the first adult case of ALL with paraneoplastic LCV.
Case presentation A 22-year-old woman presented with acute complaints of erythematous rashes on the extremities. The patient did not have weight loss, night sweats, myalgia, arthralgia, hematuria, abdominal pain, diarrhea, melena, chest pain, cough, dyspnea, hemoptysis, sputum, nor dysuria. She had no previously known illness, allergies, history of any drug use, a family history of malignancy nor rheumatological disease, and did not smoke. On physical examination, non-blanching palpable purpu
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