UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Ellen Roh MD, John McSorley MD, Drazen Jukic, MD, PhD
DECEMBER 2006 CASE OF THE MONTH
CLINICAL FINDINGS
A 61-year-old male was admitted for leukocytosis and anemia, found on routine examination by his primary care physician. His past medical history was significant only for hypercholesterolemia that was well controlled with simvastatin. He endorsed some fatigue, night sweats and a dry cough, and he reported that prior to developing these symptoms, he had traveled throughout Southeast Asia and India. During his hospitalization, dermatology was consulted for lower leg lesions, which according to the patient had been present for six months. He described them as slightly pruritic, and had been treated with topical clotrimazole without any improvement.
In general, our patient appeared to be a well-developed male in no acute distress. There were several coin-shaped erythematous patches on his lower legs (see figures 1 & 2). No lymphadenopathy could be appreciated on examination.
A punch biopsy was obtained from the left tibial lesion, which showed foci of immature myeloid and erythroid forms (see figures 3, 4 & 5), positive for CD34 (see figure 6) and glycophorin (see figure 7), in the deep dermis. In addition, there was evidence of overlying spongiosis with eosinophils and neutrophils.
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