A 37‐year‐old woman presented with a 1‐month history of tender facial pustules and erythema, rapidly progressing to confluent plaques. Physical examination revealed widespread erythematous plaques with coalescing pustules and crusts (Figure 1a), painful oral aphthae (Figure 1b) and a positive pathergy reaction. Laboratory tests showed pancytopenia. Bone marrow biopsy confirmed chronic myelomonocytic leukaemia (CMML), revealing hypercellularity with dysplasia, monocytic proliferation (45.47% by flow cytometry), myelofibrosis (MF‐1) and a complex karyotype with copy number variations involving chromosomes 1, 8, 9 and 20. Skin cultures were negative, and histopathology demonstrated a neutrophilic dermatosis with karyorrhexis.
FIGURE 1.
(a) Facial erythema plaques, pustules and crusts. (b) Oral ulceration.
The eruption was diagnosed as a paraneoplastic neutrophilic dermatosis. CMML‐associated skin lesions are rare and may precede systemic symptoms. Empirical antimicrobials failed, but oral prednisone (30 mg/day) led to rapid resolution within 2 weeks. Although clonality of skin‐infiltrating cells was not assessed, this case underscores that refractory neutrophilic dermatosis should prompt investigation for underlying myeloid malignancies like CMML.
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The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.