Superficial disseminate porokeratosis in a patient with myelodysplastic syndrome

A 70-year-old man was admitted with a diagnosis of myelodysplastic syndrome (MDS) and fever of unknown origin. He had been diagnosed with MDS 2 months prior to admission, and was treated initially with the anabolic androgen, Danazol. He had also been on prednisone, 60 mg a day for a few months for t he treatment of hemolytic anemia. Two weeks later, he noted the development of a mildly pruritic rash over his trunk and extremities. He denied any pr evious history of a similar rash as well as any family history of similar l esions. It was thought that he was having an allergic reaction to the Danaz ol and, therefore, Danazol was discontinued. The rash seemed to improve but flared again a few days prior to admission. Upon admission, his laboratory data revealed hemoglobin 9.3 gm/DL, hematocrit 27.3%, white blood cell cou nt 3300/mm(3) and platelet count 41,000/mm(3). A bone marrow biopsy showed a hypercellular marrow. Chromosome analysis of the bone marrow revealed a c omplex karyotype including the loss of chromosomes 5 and 7, the presence of an isochromosome for the entire long arm of chromosome 17, and the presenc e of an additional chromosome 21; these are characteristic chromosome aberr ations in myelodysplastic syndromes. Physical examination demonstrated disc rete, small, thread-like, annular papules over the trunk and extremities (F ig. 1). A skin biopsy was performed and was compatible with porokeratosis s howing a typical cornoid lamella (Fig. 2). He was not given any treatment f or his skin lesions and treatment for his MDS consisted solely of red cell concentrates.