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- Original article -
Erythema Nodosum and Granulomatous Lesions Preceding Acute Myelomonocytic Leukemia
Takashi Anan, Tomoyuki Imamura*, Shigeo Yokoyama** and Sakuhei Fujiwara
Department of Anatomy, Biology and Medicine (Dermatology), Oita University, Faculty of Medicine, Oita, Japan.
*Department of Infectious Diseases (Second Department of Internal Medicine), Oita University, Faculty of Medicine, Oita, Japan.
**Department of Oncological Science (Pathology), Oita University, Faculty of Medicine, Oita, Japan.
A 65-year-old female with a one-month history of painful eruptions on her lower extremities was admitted to our hospital. Histological examination revealed erythema nodosum (EN), and the patient was treated with oral prednisolone (PSL; 20 mg daily). The eruptions subsided in two weeks. One month later, painful reddish eruptions recurred on her upper limbs and abdomen in addition to her lower extremities. A skin biopsy from an abdominal erythematous plaque revealed a non-caseating granuloma without microorganisms or foreign-body materials. These eruptions also disappeared with treatment with oral PSL (20 mg daily). No underlying disease, including sarcoidosis, diabetes mellitus, or rheumatoid arthritis, was found. However, five months later, the patient developed conspicuous leukocytosis. She was diagnosed with acute myelomonocytic leukemia (M4) and treated with chemotherapy. After complete remission had been achieved, the EN reappeared, in association with an increase in blastic cells in the bone marrow. Serum levels of tumor necrosis factor-alpha and interleukin-1 beta, which are thought to be essential for granuloma formation and induction of EN, were markedly elevated. Physicians must remember that recurrent EN and granulomatous lesions can be a prodromal sign of leukemia.
key words: erythema nodosum; granuloma; acute myelomonocytic leukemia, tumor necrosis factor-alpha; interleukin-1 beta
Received January 15, 2004; Accepted for publication April 20, 2004
Reprint requests to: Takashi Anan, Department of Dermatology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita-gun, Oita 879-5593, Japan.
J Dermatol 31 (9): 741-747, 2004
Japanese Dermatological Association
http://www.dermatol.or.jp
