Concurrent chronic lymphocytic leukemia cutis and acute myelogenous leukemia cutis in a patient with untreated CLL

Patients who have chronic lymphocytic leukemia (CLL) are known to have a hi gh frequency of second malignant neoplasms. However, acute myelogenous leuk emia (AML) occurring concurrent with or after a diagnosis of CLL is extreme ly rare. In this article we report a case of AML developing in a 55-year-ol d male with a 6-year history of untreated CLL. The diagnosis was facilitate d by touch preparation of a skin punch biopsy specimen. The patient present ed with a two-week history of fever, weakness, anasarca, and a skin rash. P hysical examination revealed pink to skin-colored firm papules, which coale sced into indurated plaques on his trunk, upper extremities, and face. The lesions, in combination with generalized edema, produced a leonine facies. Touch prep of the biopsy showed medium to large blasts, large monocytoid ce lls, and numerous small mature lymphocytes, providing the preliminary diagn osis of a second, previously undiagnosed myelomonocytic malignancy in this patient. The initial diagnosis was subsequently confirmed by histologic, cy tochemical, immunohistochemical and flow cytometry studies. This is the fir st reported case of CLL with concurrent AML in which rapid touch prep of a skin punch biopsy facilitated diagnosis.