Subcutaneous eosinophilic necrosis associated with refractory anemia with an excess of myeloblasts

We followed up over a period of 10 months a Cambodian patient in whom refractory anemia with excess blasts was discovered after the onset of fever and chronic dermatologic involvement. Violaceous, firm, and painful subcutaneous nodules (1-3 cm in diameter) were present on the arms, legs, trunk, scalp, neck, and chin and were associated with violaceous infiltrating plaques on the face and forehead. The microscopic examination of repeated biopsy specimens showed a predominantly lobular panniculitis characterized by an extensive eosinophilic necrosis, leukocytoclasia, and fibrinoid deposits within a few vessels. Such lesions might be the consequence of the immune response against leukemic clones, which have been shown to be present in a steady state in at least some cases involving myelodysplastic syndromes.