1
|
Muacevic A, Adler JR, Eusébio SP, Prayce R, Pires P. From the Deep: Overlap of Neutrophilic Dermatoses Disorders Associated With Acute Myeloid Leukemia. Cureus 2023; 15:e33456. [PMID: 36751214 PMCID: PMC9897686 DOI: 10.7759/cureus.33456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
We report the case of a man in his 50s with refractory acute myelomonocytic leukaemia (AML) who presented with neck swelling, fever, and elevated levels of C-reactive protein (CPR) after venous punctures. An infected haematoma was presumed, but the patient showed no signs of improvement under broad-range antibiotics, and microbiological results were negative. The subsequent development of a rapidly evolving erythematous-violaceous plaque around a site that had previously punctured on the extensor surface of the right arm prompted us to reconsider the clinical setting as a whole and consider the hypothesis of deep neutrophilic dermatosis (ND) associated with haematologic malignancy. A biopsy of the arm lesion showed an aseptic neutrophilic infiltrate, confirming this diagnosis. The patient was initially treated with high-dose intravenous corticosteroids, resulting in a dramatic improvement of the skin lesions.
Collapse
|
2
|
Abstract
Haematological malignancies induce important alterations of the immune system, which account for the high frequency of autoimmune complications observed in patients. Cutaneous immune-mediated diseases associated with haematological malignancies encompass a heterogeneous group of dermatoses, including, among others, neutrophilic and eosinophilic dermatoses, autoantibody-mediated skin diseases, vasculitis and granulomatous dermatoses. Some of these diseases, such as paraneoplastic pemphigus, are associated with an increased risk of death; others, such as eosinophilic dermatoses of haematological malignancies, run a benign clinical course but portend a significant negative impairment on a patient’s quality of life. In rare cases, the skin eruption reflects immunological alterations associated with an unfavourable prognosis of the associated haematological disorder. Therapeutic management of immune-mediated skin diseases in patients with haematological malignancies is often challenging. Systemic corticosteroids and immunosuppressive drugs are considered frontline therapies but may considerably augment the risk of serious infections. Indeed, developing a specific targeted therapeutic approach is of crucial importance for this particularly fragile patient population. This review provides an up-to-date overview on the immune-mediated skin diseases most frequently encountered by patients with onco-haematological disorders, discussing new pathogenic advances and therapeutic options on the horizon.
Collapse
|
3
|
Wesner N, Fenaux P, Jachiet V, Ades L, Fain O, Mekinian A. [Behçet's-like syndrome and other dysimmunitary manifestations related to myelodysplastic syndromes with trisomy 8]. Rev Med Interne 2020; 42:170-176. [PMID: 33139078 DOI: 10.1016/j.revmed.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/20/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
Myelodysplastic syndromes (MDS) are clonal hematopoietic malignancies which are also characterised by immune dysregulation. The impaired immune response is mainly due to T lymphocytes (CD8 and T regulatory cells) with increased cell apoptosis. MDS could be associated in some cases with various clinical dysimmune features; however, only MDS with trisomy 8 is correlated with particular clinical phenotype. The latter is mainly Behçet's-like disease which includes orogenital aphtosis, skin features and severe ulcerative digestive disease of ileocaecal distribution. Other clinical manifestations, such as arthritis or neutrophilic dermatosis, have been also described in MDS patients with trisomy 8. The dysimmune manifestations, and among them the Behçet's-like disease, do not impact the overall survival or the risk of progression to acute myeloid leukemia. Immunosuppressive and immunomodulatory therapies, and among them TNF-α inhibitors, are usually ineffective to control the dysimmune manifestations. Targeting the underlying clonal disease with specific therapies, such as azacitidine, seems to be the best strategy to control these disorders, even in MDS patients with low-risk disease.
Collapse
Affiliation(s)
- N Wesner
- Department of internal medicine, inflammation-immunopathology-biotherapy department (DMU I3), Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, Sorbonne université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne universités, Inserm U938, centre de recherche Saint-Antoine (CRSA), Paris, France
| | - P Fenaux
- Department of hematology, Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, 75010 Paris, France
| | - V Jachiet
- Department of internal medicine, inflammation-immunopathology-biotherapy department (DMU I3), Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, Sorbonne université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne universités, Inserm U938, centre de recherche Saint-Antoine (CRSA), Paris, France
| | - L Ades
- Department of hematology, Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, 75010 Paris, France
| | - O Fain
- Department of internal medicine, inflammation-immunopathology-biotherapy department (DMU I3), Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, Sorbonne université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne universités, Inserm U938, centre de recherche Saint-Antoine (CRSA), Paris, France
| | - A Mekinian
- Department of internal medicine, inflammation-immunopathology-biotherapy department (DMU I3), Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, Sorbonne université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne universités, Inserm U938, centre de recherche Saint-Antoine (CRSA), Paris, France.
| | | |
Collapse
|
5
|
Montagnon CM, Fracica EA, Patel AA, Camilleri MJ, Murad MH, Dingli D, Wetter DA, Tolkachjov SN. Pyoderma gangrenosum in hematologic malignancies: A systematic review. J Am Acad Dermatol 2019; 82:1346-1359. [PMID: 31560977 DOI: 10.1016/j.jaad.2019.09.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/15/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a devastating neutrophilic dermatosis that may be associated with trauma or systemic diseases. The associations, characteristics, and temporal relationship of PG with hematologic malignancies are not well understood. OBJECTIVE We performed a systematic review of PG associated with hematologic malignancies using data from case reports, case series, and retrospective studies. METHODS We searched MEDLINE, EMBASE, Scopus, and Web of Science from each database's inception to December 12, 2018. Two reviewers independently selected studies and extracted data. RESULTS Two hundred seventy-nine publications met the inclusion criteria (340 cases). Myelodysplastic syndrome (MDS) was the most commonly reported hematologic malignancy associated with PG, followed by monoclonal gammopathy of undetermined significance and acute myeloid leukemia. The mean age of patients was 56.5 years, with males being more common. There was a predominance of the ulcerative PG subtype and multifocal distributions across all hematologic malignancies. The majority of MDS cases preceded PG, which was reversed for MGUS. LIMITATIONS The data were limited by reporting bias because PG subtypes rely on the rendered diagnosis reported. In addition, the classification for hematologic malignancies has evolved since 1978. CONCLUSION Patients with PG should be evaluated for hematologic malignancies, with MDS being the most common.
Collapse
Affiliation(s)
| | | | - Archna A Patel
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
6
|
Lepelletier C, Bouaziz JD, Rybojad M, Bagot M, Georgin-Lavialle S, Vignon-Pennamen MD. Neutrophilic Dermatoses Associated with Myeloid Malignancies. Am J Clin Dermatol 2019; 20:325-333. [PMID: 30632096 DOI: 10.1007/s40257-018-00418-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Neutrophilic dermatoses (ND) are a group of conditions characterized by an aseptic accumulation of polymorphonuclear leukocytes in the skin. Occurrence of ND in association with myeloid malignancies, mainly myelodysplastic syndrome and myelogenous acute leukemia, is not rare and is often associated with a poor prognosis. Recent findings have improved understanding of the pathophysiology of myeloid malignancy-associated ND. We review the clinical spectrum of myeloid malignancy-associated ND with an emphasis on recently identified mechanisms. Myeloid leukemia cells retain the potential for terminal differentiation into polymorphonuclear leukocytes in the skin. Many studies suggest a clonal link between myeloid malignancies and ND. Activation of autoinflammatory pathways (NOD-like receptor family pyrin domain-containing-3, Familial Mediterranean Fever Gene) in the clonal cells of myeloid disorders may also be involved in this setting.
Collapse
|
7
|
Lee SS, Ahn JS, Yun SJ, Park DJ. Successful treatment of a patient with myelodysplastic syndrome accompanied by pyoderma gangrenosum and Behçet's disease using allogeneic stem cell transplantation. Blood Res 2017; 52:319-321. [PMID: 29333411 PMCID: PMC5762745 DOI: 10.5045/br.2017.52.4.319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/05/2017] [Accepted: 05/25/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Seung-Shin Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Dong-Jin Park
- Division of Rheumatology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| |
Collapse
|