(BMJ)—A 46-yo woman w/ facial disfigurement x6mo that led to social isolation sought medical attention when she developed lethargy. Exam: “leonine-like” facies. Labs: WBC = 20×109/L, Hgb = 6.8 g/dL, plt = 79×109/L. Facial changes resolved w/ tx. What is the dx?
Lepromatous leprosy
Leishmaniasis
Leukemia cutis
Cutaneous lymphoma
Systemic amyloidosis
You are correct. Leukemia cutis was confirmed w/ bone marrow bx and punch bx of the skin, showing dense infiltration of malignant cells consistent w/ extramedullary involvement of leukemia. DDx includes lepromatous leprosy, systemic amyloidosis, cutaneous lymphoma, and leukemia. This pt started induction tx w/ cytarabine and daunorubicin. By day 5, she had recovered her premorbid appearance.

BMJ 2018;360:j5605