NEUTROPHILIC DERMAL INFILTRATES IN GRANULOCYTOPENIC PATIENTS WITH ACUTE-LEUKEMIA

Acute febrile neutrophilic dermatosis (AFND, Sweet's syndrome) is clin ically characterized by fever, neutrophilic leukocytosis, and tender d ermal plaques. Histological examination typically reveals infiltration of the dermis by neutrophils. In three patients (2 female, 1 male, 54 -59 years) with acute leukemia (2 myelogenous, 1 lymphoblastic) dermal plaques developed during febrile episodes in chemotherapy-induced pan cytopenia. The clinical appearance was compatible with AFND. The diagn osis was substantiated by skin biopsies which showed dense neutrophili c dermal infiltrates without leukemic cells. Leukocytoclastic vasculit is was considered as differential diagnosis. Plasma levels of soluble adhesion molecules ICAM-1, VCAM-1, and E-selectin regulating leukocyte transendothelial migration were in the normal range. Systemic glucoco rticoids were avoided because of the high risk of infection during pro longed bone marrow aplasia. The lesions were treated with topical ster oids and resolved without scarring within 1-5 weeks. AFND has been rep orted in association with acute leukemia at normal or elevated white b lood eel counts. Although implausible from a pathophysiological point of view, similar neutrophilic dermal infiltrates were found in three p atients during chemotherapy-induced pancytopenia with white blood cell counts distinctly below 1x10(9)/l.