title: Bullous pyoderma gangrenosum as the presenting sign of fatal acute myelogenous leukemia.
abstract: Bullous pyoderma gangrenosum begins as a bulla, nodule or nonulcerated erythematous plaque that blisters or ulcerates to form a superficial ulcer surrounded by a hemorrhagic, bullous border, which is surrounded by a blue-gray halo. Bullous pyoderma gangrenosum is most commonly associated with hematologic malignancies, specifically, acute myelogenous leukemia (AML). We report a patient whose initial presentation with bullous pyoderma gangrenosum prompted the appropriate diagnostic evaluation and confirmation of AML, which was ultimately fatal. We emphasize that a thorough hematologic investigation, including bone marrow biopsy, should be performed in all patients who present with lesions clinically suggestive of bullous pyoderma gangrenosum because the skin lesion may be the only indicator of the underlying hematologic disorder.
authors.affiliation: Department of Dermatology, Yale University School of Medicine, New Haven, CT 06520-8059, USA. lindy.fox@yale.edu
authors.forename: Lindy Peta
authors.initials: LP
authors.lastname: Fox
authors.forename: Adam S
authors.initials: AS
authors.lastname: Geyer
authors.forename: Sameera
authors.initials: S
authors.lastname: Husain
authors.forename: Marc E
authors.initials: ME
authors.lastname: Grossman
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016393:Lymphoma, B-Cell / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D017511:Pyoderma Gangrenosum / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology