Atypical cutaneous myeloid infiltrate in myelodysplastic syndrome: a case report

We report the case of a 31-year-old man with an atypical myeloid dermal infiltrate manifested by a 1.5-year history of recurrent erythematous plaques over his body that previously were shown to be culture positive for Staphylococcus aureus and had responded well to oral antibiotic treatment. The ultimate diagnosis was refractory anemia with excess blasts-2 (RAEB-2), a myelodysplastic syndrome (MDS). Whether it is a specific or nonspecific lesion, cutaneous involvement in MDS is a poor prognostic factor. Leukemia cutis (LC), a specific dermal infiltrate of malignant hematopoietic cells, particularly is associated with progression to acute leukemia. However, the pathology of our patient's lesions revealed a more sparse sprinkling of atypical mononuclear cells indicative of an inflammatory recruitment of leukemic cells to the dermis. Nonetheless, the guarded prognosis of this high-risk subtype of MDS mandates continued monitoring for development of LC and progression to leukemia.