Year :
2011
| Month :
October
| Volume :
5
| Issue :
5
| Page :
1106 - 1108
Full Version
Leprosy in Chronic Lymphocytic
Leukaemia: Rare Case Report
Published: October 1, 2011 | DOI: https://doi.org/10.7860/JCDR/2011/.1541
Sudhakar Rao K.M., Jayashree Pawale, Ankad B.S., Varna Naidu, H.B. Kotbagi
Corresponding Author.
Assistant professor in Dept of pathology, SN medical
college, Bagalkot, India.
Assistant Professor,Dept of Dermatology,SN medical
college, Bagalkot, India.
Assistant Professor,Dept of Dermatology,SN medical
college, Bagalkot, India.
Professor, Dept of pathology,SN medical college,
Bagalkot, India.
Correspondence Address :
Sudhakar Rao K.M.
C-9 staff quarters, SN Medical College,
Bagalkot, Karnataka - 587101.
Phone: 9972315388.
E-mail: address:drkmsudhakarrao@gmail.com.
Abstract
This is a case report of a rare chronic lymphocytic leukaemia with lepromatous leprosy. A fifty nine year old male presented with epistaxis and abdominal pain. Investigations revealed high leucocyte count of 72,600cells/cmm, a differential count of 89% lymphocytes and 11% polymorphs and a platelet count 13,000cells/cmm. The case was diagnosed as chronic lymphocytic leukaemia and pulse chemotherapy was started. Three months after the chemotherapy, the patient developed a painful, non-pruritic, tender nodule, which on biopsy, showed histiocytic granulomas in the dermis. AFB staining showed globi and fragmented baciili. The patient received treatment for both leukaemia and leprosy. After six months, the lesions are becoming faint. On follow up, the patient has been found to be recovering.
Keywords
Leprosy, Chronic lymphocytic leukaemia (CLL)
Introduction
Introduction
This is a case report of chronic lymphocytic leukaemia with lepromatous leprosy. The association between malignancies and leprosy is rare. The commonest associations of leprosy with carcinoma which have been reported, are carcinoma of the internal organs, squamous cell carcinoma in trophic ulcer, lymphoma and leukaemia (1),(2),(3). This is the second case of leprosy with chronic lymphocytic leukaemia, which has been noted so far in the literature (1).
Case Report
A fifty nine year old male presented with bleeding from nose, abdominal pain, fever and malaise to the physician. Investigations revealed Hb of 10.9%, a total leucocyte count of 72,600cells/cmm, a differential count of 89% lymphocytes and 11% polymorphs and a platelet count of 13,000cells/cmm. The case was diagnosed as chronic lymphocytic leukaemia. The physician started with pulse chemotheraphy (chlorambucil and prednisolone). Three months after the chemotherapy, he noticed painful, non-pruritic rashes over the trunk and the extremities, which were associated with fever, joint pain and pedal oedema. So, the patient was referred to the dermatological section. Examination of the skin revealed multiple tender nodules over the trunk and over the extensor aspect of the upper and lower limbs, madorosis, epistaxis and pedal oedema. No patches or mucosal involvement or peripheral nerve thickening were seen.
A differential diagnosis of leprosy with the type II reaction, erythema nodusum (tuberculids) and sweet syndrome was given.
A biopsy of the skin was taken and it was sent to HPR. The histopathological examination of the skin showed thinning of the epidermis, thus revealing a grenz zone with sheets of macrophage in the dermis. Acid fast bacilli staining showed globi and fragmented AFB bacilli. The histopathological diagnosis which was made was lepromatous leprosy.
The patient was then given treatment for leukaemia and leprosy simultaneously. The skinlesion then became faint(Table/Fig 1),(Table/Fig 2),(Table/Fig 3),(Table/Fig 4),(Table/Fig 5).
Discussion
Skin manifestations in chronic lymphocytic leukaemia are common and include non-specific leukaemids (these are the rashes which are intensely pruritic and the biopsy fails to show any leukaemic infiltration) (4), exfoliative dermatitis, urticaria, hyperpigmentation and non-specific eczematous eruptions (5)(6).
In our case, tender nodules were noticed over the trunk and the extremities, whereas in erythema nodosum, the nodules are commonly noticed over the pretibial region (7).
The histopathological sections which were studied in our case showed histiocytic granuloma with plenty of AFB bacilli on special staining, whereas in erythema nodosum, there could have been panniculities (8). So, the diagnosis of erythema nodosum was ruled out.
The presence of AFB globi and the grenz zone and the absence of secondary epidermal changes ruled out other forms of cutaneous tuberculosis (9).
In sweets syndrome, the patients present with tender nodules anywhere over the body and dermal neutrophilic infiltration, which were not seen in our case (10), (11).
In cases of drug reactions, the patients present with itching, mucosal involvement and eosinophilia, whereas in our case, there was no itching, mucosal involvement, or eosinophilia . The patient was taking steroids for CLL and so the chances for drug reactions were less (12).
Conclusion
Leprosy has rarely been reported with chronic lymphocytic leukaemia. The occurrence of leprosy in this patient with chronic lymphocytic leukaemia was probably coincidental. It appears that the administration of corticosteroids and chlorambucil had resulted in the exacerbation of the leprosy lesions. Only two cases of leprosy with chronic lymphocytic leukaemia have been reported so far in the literature (1).
Reference
| 1. | Purtilloa DT, Pangi C. Incidence of cancer in patients with leprosy. Cancer 1975;35:1259-1261. | 2. | Reddy NBB, Shrinivasan T, Krisnan SAR, Bhusnurmat SR. Malignancy in chronic ulcer in leprosy –A report of five cases from northern Nigeria. Leprosy 1985;56;249-253. | 3. | Swamy S, Durai V, Oommen PK, Rao KS. Cauliflower growth in trophic ulcer of leprosy–a 10 year study. Indian Journal of leprosy 1986; 58:48-53. | 4. | Dutcher JP, Wiernik PH. The Leukemias chapter 16, in clinical Medicine. JA Ed spittle Harper and Row Philadelphia; 1984; 5:1-26. | 5. | Former JW. Lymphoma cutis, multiple myeloma , leukemia cutis and mycosis fungoides in dermatology. Ed Moschella, Pillbury and Hurley, Saunders, phildephia.;1975; 2:1422-1423. | 6. | Patterson JW, Blaylock WK. Leukemia cutis. chapter 20-13, in Clinical Dermatology. Ed demis DJ, Harper and Row Philadelphia; 1985; 1:1-9. | 7. | Gilchrist H, Patterson JW. Erythema nodosum and erythema induratum (nodular vasculitis):diagnosis and management. Dermatol Ther. 2010;23/4:320-7. | 8. | Handa R, Ramam M, Verma KK. Panniculitides -a clinicopathologic study. J Asso Physicians India. 2002; 50:1008-12. | 9. | Jain V K, Aggarwal K, Jain S et al. Hypertrophic Lupus Vulgaris: an unusual presentation. Indian J Dermatol. 2009; 54(3):287-289. | 10. | Mahajan VK, Sharma NL, Sharma RC. Sweet’s syndrome from an Indian perspective : a report of four cases and review of the literature. Int J Dermatol. 2006;45(6):702-8. | 11. | Cohen PR, Kurzrock R. Sweet’s syndrome revisited: a review of the disease concepts. Int J Dermatol. 2003;42(10):761-78. | 12. | Artukovic M, Kustelega J, Lugovic-Mihic L. DRESS Syndrome with mild manifestations as a diagnostic and therapeutic problem: A case report. Acta Clin Croat. 2010; 49(4):479-84. |
|