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Pernio. A possible association with chronic myelomonocytic leukemia.

Florid pernio occurred in an elderly man with chronic myelomonocytic leukemia (CMML). Previous case reports showed four elderly men with pernio and a hematologic disorder. Retrospective examination of the reported hematologic features of these cases enabled us to identify them as cases of CMML. Pernio preceded the diagnosis of the leukemia in all cases. We suggest that pernio may occur as an initial manifestation of CMML. The pathogenesis of pernio in association with CMML remains unclear.

Chilblains↗

Case report 724. Yaws.

A 15-year-old girl presented with the typical clinical, serological, and pathological lesions of yaws. The patient was a native of Sumatra. The important diagnostic criteria and the relationship to venereal syphilis were discussed.

Adolescent↗

Paraproteinaemia in erythema elevatum diutinum.

Paraproteinaemia (IgGkappa) was observed in a 68 year-old patient with erythema elevatum diutinum. The association of this skin disease with paraproteinaemia as already reported by other authors may indicate a pathogenetic relationship.

Aged↗

Spirochetes in atrophic skin lesions accompanied by minimal host response in a child with Lyme disease.

Acrodermatitis chronica atrophicans, which has rarely been observed in the United States, is a late skin manifestation of Lyme borreliosis. A 12-year-old girl who spent summers on Cape Cod presented with a 2-year history of hyperpigmentation and atrophy of the skin on the hands, wrists, and ankles. The skin biopsy specimen of an affected area showed mild dermal fibrosis, a few inflammatory cells, and spirochetes morphologically compatible with Borrelia burgdorferi. An IgG antibody response to B. burgdorferi could be elicited by immunoblotting, but not by enzyme-linked immunosorbent assay. We conclude that this patient had chronic Lyme borreliosis manifested only by indolent infection of the skin.

Acrodermatitis↗

Disseminated pagetoid reticulosis: need for long-term follow-up.

A 54-year-old woman had an erythematous plaque on the left index finger for 2 years. Histologically there was a dense infiltrate of atypical mononuclear cells in the epidermis that produced a pagetoid appearance. A diagnosis of localized pagetoid reticulosis was made. Three years after total removal of the finger lesion, erythematous plaques appeared on her left thigh, followed by the development of similar plaques on the right thigh and lower abdomen. Histologically these skin lesions had the same pagetoid appearance as the plaque on the finger. This suggested development of the disseminated type of pagetoid reticulosis, long after removal of the initial skin lesion.

Diagnosis, Differential↗