CUTANEOUS PRESENTATION OF JUVENILE CHRONIC MYELOGENOUS LEUKEMIA - A DIAGNOSTIC AND THERAPEUTIC DILEMMA

Annular, erythematous, circinate plaques were the first manifestation of juvenile chronic myelogenous leukemia (JCML) in an otherwise health y 2.5-year-old boy who had had these lesions since 6 months of age, Th e lesions showed an atypical hematopoietic infiltrate on biopsy, Biops y of a bone marrow specimen and peripheral blood smear were normal six months before leukemic transformation. At 3 years of age the bay deve loped splenomegaly, thrombocytopenia, and petechiae, and a bone marrow aspirate and cell marker studies were regarded as consistent with, if not diagnostic of, JCML, Four previous cases of cutaneous leukemic in filtrate associated with JCML have been published, Our patient had rec urring urticarial-like plaques for two years before the initial bone m arrow finding of JCML. Given the poor prognosis and progressively evol ving course of JCML, it may be appropriate to consider therapy before bone marrow changes, based on the presence of the cutaneous eruption w ith the appropriate findings on skin biopsy and an elevated fetal hemo globin.