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21 June 2017 : Case report  Brazil

Blastic Plasmacytoid Dendritic Cell Neoplasm with Pulmonary Involvement and Atypical Skin Lesion

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare disease, Clinical situation which can not be reproduced for ethical reasons

Cyndi Myrelle da Silva Barros Romão1ABDEFG, Cláudio José dos Santos Júnior1ADEF, Luiz Arthur Calheiros Leite23ADEFG*, Maria Jordana Rocha Gomes Alves1BDF, Nathalia Silva Araújo45DEF, Anderson F L Castro6B, Muriel Silva Moura5BDE, Vitória Mikaelly da Silva Gomes7ABDE, Arthur Moacir Costa Sampaio Batinga7AD, João Antonio S Queiroz3DE, Natanael Barbosa dos Santos47D

DOI: 10.12659/AJCR.903059

Am J Case Rep 2017; 18:692-695

Abstract

BACKGROUND: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematodermic malignancy neoplasm with highly aggressive course and poor prognosis. This disease typically presents with cutaneous involvement as the first manifestation, with subsequent or simultaneous spread to bone marrow and peripheral blood. 

CASE REPORT: Here, we report the case of a 51-year-old woman who presented a violaceus skin lesion on the lateral region of the right thigh, weight loss, fever, and lymphadenopathies. Computed tomography (CT) displayed thoracic and abdominal lymph node and alveolar bleeding. Flow cytometry from circulating blastic cells was compatible with BPDCN (CD4+, CD56+ and CD123+). She underwent 5 cycles of hyper-CVAD alternating with high-dose methotrexate and cytarabine, but the patient died due to alveolar bleeding and sepsis.

CONCLUSIONS: We report a rare case of BPDCN characterized by an aggressive course, presence of atypical skin lesion, a finding suggestive of pulmonary infiltration, and nonresponse to induction chemotherapy, leading to late diagnosis and therapeutic management. Because of the late recognition of the skin lesion, neoplastic cells infiltrated the dermis and spread as the disease progressed rapidly to a fatal course.

Keywords: Leukemia, Myeloid, Acute, Lung Compliance, Rare Diseases, Skin Neoplasms

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923