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Leukaemia cutis in a 12-year-old boy with acute myeloblastic leukaemia and severe malnutrition: A case report

Abstract

Abstrak

Leukaemia adalah neoplasma ganas yang mempengaruhi sistem hematopoetik. Insiden rerata 4-4,5 kasus / tahun / 100.000 pada anak-anak berusia kurang dari 15 tahun. Leukaemia cutis adalah infiltrasi sel leukaemia agresif ke dalam lapisan epidermal, dermis, dan sub-cutis. Kejadiannya sangat jarang, bisa terjadi pada semua jenis leukaemia. Seorang anak lelaki berusia 12 tahun, dirujuk dengan demam intermiten, pucat dan perdarahan gusi sejak 10 bulan serta benjolan di kulit sejak 2 bulan sebelum masuk rumah sakit. Pemeriksaan fisik menunjukkan hiperplasia gingiva, massa multipel 1-3 cm di kepala, leher, dada, perut dan tangan, hepatomegali dan splenomegali. Status gizi adalah gizi buruk. Pemeriksaan laboratorium menunjukkan leukositosis, anaemia ringan, dan trombositopenia berat. Aspirasi sumsum tulang terjadi kecurigaan AML dengan 10% myeloblast, dan 5% monoblast. Biopsi kulit menunjukkan infiltrasi kulit oleh myeloblast dan monoblast. Pasien didiagnosis dengan leukaemia mieloblastik akut, leukaemia kutis, dan gizi buruk. Kemoterapi dengan protokol leukaemia akut non-limfoblastik. Setelah 4 bulan kemoterapi, keluarga memutuskan untuk tidak melanjutkan kemoterapi dan hanya terapi suportif seperti transfusi. Pasien meninggal 9 bulan setelah diagnosis.


Abstract

Leukaemia is a malignant neoplasm affecting the hematopoietic system. Incidence averages 4-4.5 cases/year/100.000 in children younger than 15 years. Leukaemia cutis is an aggressive leukaemia cell infiltration into the epidermal, dermis, and sub-cutis layers. The incidence is infrequent, can occur in all types of leukaemia. A 12-year- old boy, referred with pale, intermittent fevers, gum bleeding from 10 months and lumps on the skin from 2 months before admission. Physical examination was showed gingival hyperplasia, multiples mass of 1-3 cm in diameter in the head, neck, thoracic, abdominal and hand region, hepatomegaly and splenomegaly. The nutritional status was severe malnutrition. Laboratory examinations showed leukocytosis, mild anaemia, and severe thrombocytopenia. Bone marrow aspiration occurs AML suspicion with 10% myeloblast and 5% monoblast. Skin biopsy suggests cutaneous infiltration by myeloblast and monoblast. A patient diagnosed with acute myeloblastic leukaemia, leukaemia cutis, and severe malnutrition — chemotherapy with guided by non-lymphoblastic acute leukaemia protocol. After 4 months of chemotherapy patients and families decided not to continue chemotherapy and only supportive therapy such as transfusion. The patient passed away 9 months after the diagnosis.Leukaemia cutis is uncommon as the presenting feature of AML and is associated with an unfavourable prognosis. There is no specific treatment for cutaneous leukaemia other than palliation and symptomatic relief. The 2-year survival rate for the unfavorable prognostic group it is 10-20%.

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How to Cite

Assa, N., & Ariawati, K. (2019). Leukaemia cutis in a 12-year-old boy with acute myeloblastic leukaemia and severe malnutrition: A case report. Medicina, 50(3). https://doi.org/10.15562/medicina.v50i3.566

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