Chronic Lymphocytic Leukemia appearing as skin lesions Gonçalves Estevens, J.; Rodriguez Vera, J.; Vylchez, J.; Ferreira, Mª L.; Arez, L.

Cutaneuos lesions are not common in CLL, and that is the reason why we chose this case for its rarity. WE present the case of a 75 years old man who consulted to the Emergency Department of our Hospital for a bleeding lesion with spontaneous intermittent remission in the frontal region from 4 months. He also referred having found not painful enlarged lymph nodes in the axilar and cervical regions from one month.. Blood test taken at admission showed a leucocytosis of 133.200/ μl, with 9,5% of neutrophils, 63,7 lymphocytes (35% pro-lymphocytes); platelets 149.000/μL; β2-microglobulin of 5,02, LDH 1799UI/L; ESR 1. Peripheral blood smear showed nuclear shadows. An excision of the axilar adenopathy was done, biopsy being reported as a lymph node involvement for a chronic lymphatic leukaemia B, CD5+ and CD20+ . Cutaneous biopsy showed a scamous lesion with acantosis, focal spongiosis, edema of the papilar dermis and a nodular and anexial prominent lymphocytic involvement with abundant eosinophils in all the extension of the dermis and fat paniculus up to the limit of the sample. Lymphocytes were small, with positivity to CD 5, CD 20 and CD 43. The above mentioned data might be interpreted as an exaggerated reaction to an athropode bite in the context of a lymphoproliferative disease, most common in chronic lymphocytic leukaemia. A sample of the skin biopsy was sent to Prof. L. Cerroni, in Graz , Austria, who confirmed the diagnostic hypotesis done. Treatment with oral fludarabine was initiated, with a good clinical course. .