[Skin manifestations associated with myelodysplastic syndromes]

Relapsing Polychondritis: A Review and Guide for the Dermatologist

Relapsing polychondritis, or RP, is a rare connective tissue disease characterized by relapsing-remitting destructive inflammation of the cartilaginous and other proteoglycan-rich structures in the body. Given the relatively low incidence of RP, a concise clinically relevant guide, focusing on the cutaneous manifestations of this serious disease, is lacking. In this review, we provide the dermatologist with an approach to diagnosing RP and a guide to its initial work-up, and management. We close with an overview of the currently available treatment modalities for RP.

Papular and annular fixed urticarial eruption: a characteristic skin manifestation in patients with relapsing polychondritis

BACKGROUND

Skin manifestations of relapsing polychondritis (RP) are usually nonspecific.

OBJECTIVE

We report a series of patients with RP who presented with annular skin lesions.

METHODS

The clinical and histologic features and follow-up data of patients with RP and an annular urticarial eruption were retrospectively reviewed.

RESULTS

Ten patients (9 male, 1 female) (mean age 63.7 years) were included. All patients had tense, fixed, urticarial papules with an annular configuration predominantly located on the upper part of the trunk. Skin lesions occurred before the chondritis in 7 of 10 cases with a mean delay of 23 ± 13 months. Histologic examination consistently showed a lymphocytic vasculitis with no leukocytoclastic vasculitis, even when biopsies were repeated during the evolution (n = 7). Hematologic abnormalities were found in all cases. A myelodysplastic syndrome was found in 4 patients. Oral corticosteroids were effective in all cases, although skin lesions recurred during the decrease of corticosteroid doses in 4 cases. Five patients died during the evolution.

LIMITATION

Retrospective case series design is a limitation.

CONCLUSION

Annular and papular fixed urticarial eruption may represent a characteristic skin manifestation of RP. It is frequently associated with hematologic abnormalities and may auger a poor prognosis.

Panniculitis as the presenting sign of a myelodysplastic syndrome in an adolescent boy

Panniculitis is an uncommon condition in childhood and may prove difficult to diagnose both clinically and histologically. The clinical spectrum is similar to that in adults and has been associated with many primary diseases. Noninfectious causes are less common in children than in adults. The pathogenesis remains uncertain in a significant number of children. In some it may be a malignant, unremitting disease which can be fatal. We present a boy aged 13 years with panniculitis of the right foot as presenting sign for the ultimate diagnosis myelodysplasia-acute myeloid leukemia. To our knowledge this is the first report on a young boy.

Cutaneous leukocytoclastic vasculitis and myelodysplastic syndrome with little or no evidence of associated autoimmune disorders-a case report and a brief review of the literature

Cutaneous leukocytoclastic vasculitis (CLV) is a necrotizing inflammatory disease of the small vessels in the dermis. Approximately 50% of cases with CLV are primary or idiopathic and the remainder may be associated with various diseases. Less than 1% CLV occurs in association with malignancies including leukemia, lymphoma, and myelodysplastic syndrome (MDS). The pathogenetic mechanism of CLV remains speculative and is generally believed to be related to autoimmune processes. We report here a 77-year-old white woman who presented with contemporaneous occurrence of CLV and MDS (WHO subtype RAEB-2). Autoantibodies and immune-complexes were not detected either in the serum or by direct immunofluorescense in the skin biopsy. The clinical course of MDS remained steady, but the cutaneous lesion resolved within 2 weeks with minimal or no specific therapy except corticosteroids. We suggest that absence of autoimmune phenomena and immune-complex in the skin lesions of CLV may be a hallmark of good prognosis.

[Diabetes insipidus revealing chronic myelomonocytic leukemia]

INTRODUCTION

Central diabetes insipidus is most frequently reported to occur after a trauma from surgery or accident. However, between 30 and 50% of cases are considered idiopathic. It's a rare complication of myelodysplastic syndrome.

CASE REPORT

A 61-year-old patient presented central diabetes insipidus revealing, 17 months before, chronic myelomonocytic leukemia. Cytogenetics studies revealed monosomy 7. Acute myeloid leukemia appears 3 months after training rapid patient's death.

DISCUSSION

Blood examination is necessary before to conclude idiopathic central diabetes insipidus. The discovery of chronic myelomonocytic leukemia implicates a rapid managing before its possible acute myeloid leukemia transformation. Indeed, prognosis of central diabetes insipidus and acute myeloid leukemia associated, in presence of monosomy 7, is very poor.

Myelodysplastic syndrome presenting as acquired ichthyosis

Ichthyosis is a cutaneous keratinization disorder that can either be congenital or acquired. Acquired ichthyosis has been reported in association with a variety of neoplastic, autoimmune, and infectious diseases. We report the case of a 68-year-old woman who presented with generalized ichthyosis as the first manifestation of myelodysplastic syndrome. This is the first fully described case of such an association in the English literature.

Cutaneous paraneoplastic syndromes: uncommon presentations

Paraneoplastic syndromes are a group of clinical manifestations associated with a malignancy, but not directly related to the primary tumor itself or to its metastases. Characteristically, they follow a course parallel to the tumor, resolve with successful treatment of the primary tumor, and tend to recur with its relapse or the onset of metastases. The mechanism by which they occur is not well understood, but may be related to the production of bioactive substances by or in response to the tumor, such as polypeptide hormones, hormone-like peptides, antibodies or immune complexes, cytokines, or growth factors.

Manifestations immunes associées aux syndromes myélodysplasiques. Étude prospective de 40 patients

The association of myelodysplastic syndromes (MDS) with auto-immune diseases and humoral disorders have already been reported. In this prospective study we tried to estimate type and the frequency of immunological associated diseases among patients affected by MDS.

PATIENTS-METHODS

In this prospective study, auto-immune disease and humoral immunity disorders were systematically searched during MDS and conversely MDS searched during cytopenia. All MDS secondary to chemotherapy and the children's MDS were excluded. The MDS diagnosis was established according to FAB criteria and patients were classified in two groups A or B according to presence (group A) or not (group B) of dysimmune manifestations.

RESULTS

Forty patients(19 males and 21 females, mean age of 56,6 years) with MDS have been enrolled during this period (group A: 20 patients). Associated diseases are following: systemic lupus erythematosus (three), lupus-like syndrome(one), sarcoidisis(one), Sjogrën syndrome(one), polyarthritis (two), chronic liver diseases (three), autoimmune thyroid diseases (two), pyoderma gangrenosum (one), Crohn's disease(one), haemolytic anaemia (one), and pericardial effusion(one).

CONCLUSION

A wide spectrum of auto-immune manifestations is frequently reported in myelodysplastic syndromes. Further studies are necessary for discuss the current physiopathological hypothesis with their therapeutic relevance.