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Myelodysplasia presenting with pulmonary manifestations associated with neutrophilic dermatosis
F P Peters1, M Drent, M Verhaegh
1Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
Abstract:
We present the case of a patient who suffered from severe pneumonia. Extensive diagnostic procedures revealed negative cultures and a severe neutrophilia in the bronchoalveolar lavage fluid suggestive of Sweet's syndrome. The persistent toxic leukocyte differentiation (not induced by infection) suggested an underlying hematologic disorder. One week later, she developed cutaneous lesions indicative of neutrophilic dermatosis. Bone marrow investigation showed refractory anemia with excess of blasts (RAEB). Both the pulmonary and cutaneous infiltrates improved after treatment with chemotherapy.
Insights
This case study highlights a patient with severe pneumonia and skin lesions, ultimately diagnosed with refractory anemia with excess blasts (RAEB). Chemotherapy effectively treated both the pulmonary and cutaneous manifestations.
Area of Science:
- Hematology
- Pulmonology
- Dermatology
Background:
- Severe pneumonia can present with atypical features requiring extensive diagnostics.
- Neutrophilic inflammation in bronchoalveolar lavage fluid may indicate conditions beyond infection.
Observation:
- A patient presented with severe pneumonia, exhibiting neutrophilia in bronchoalveolar lavage fluid, initially suggestive of Sweet's syndrome.
- Persistent toxic leukocyte differentiation, unrelated to infection, prompted investigation for hematologic disorders.
- The patient subsequently developed cutaneous lesions characteristic of neutrophilic dermatosis.
Findings:
- Bone marrow examination revealed refractory anemia with excess of blasts (RAEB).
- Pulmonary and cutaneous infiltrates showed improvement following chemotherapy.
Implications:
- This case underscores the importance of considering hematologic malignancies in patients with unexplained neutrophilic inflammation and multi-organ involvement.
- Early recognition and treatment of underlying hematologic disorders are crucial for managing complex presentations involving pulmonary and dermatologic manifestations.
- Chemotherapy can be an effective treatment modality for RAEB presenting with severe pneumonia and neutrophilic dermatosis.