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Sunday, November 22, 2020

Case and Review: Cutaneous Involvement by Chronic Neutrophilic Leukemia versus Sweet Syndrome, a Diagnostic Dilemma

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Abstract

Chronic neutrophilic leukemia (CNL) is a rare leukemia with approximately 150 total cases reported. Cutaneous neutrophilic infiltrates, including Sweet syndrome (SS) and leukemia cutis (LC), have been reported in six patients with CNL. In the setting of CNL, these two conditions are difficult to differentiate due to clinical and histological similarities, but it is important to do so because leukemia cutis is associated with a worse prognosis. In general, Sweet syndrome is distinguished by its tenderness, fever, and improvement with steroids (vs chemotherapy for LC). Biopsy of LC reveals immature leukocytes, whereas SS shows almost exclusively mature leukocytes, but morphology alone may not be sufficient in some cases. Here we report a case of a 72‐year‐old male with CNL and a cutaneous eruption with clinical and pathologic features which made the distinction between the two diseases difficult.

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