title: The diagnostic yield of skin biopsy in patients with leukemia and suspected infection.
abstract: OBJECTIVE
  To determine the diagnostic yield of skin biopsy in patients with leukemia, new skin lesions, and suspected infection.
  
  
  METHODS
  We reviewed the medical records of all patients with leukemia who underwent skin biopsy for new lesions and clinical suspicion of infection over 4 years. Biopsy was considered to have changed the diagnosis, if the results differed from the prior leading clinical impression.
  
  
  RESULTS
  Seventy-six (39%) of 195 patients had infections identified via skin biopsy. Among the remaining patients, the most common diagnoses were leukemia cutis, drug reactions and Sweet's syndrome. Ulcerated or necrotic lesions and bacteremia or fungemia were the only independent predictors of infection. 55% of patients with severe neutropenia had biopsy-proven infectious causes of their skin lesions. One third of all afebrile patients had skin manifestations owing to infection. Skin biopsy results differed from the initial clinical impression in 34% of all patients. In 45% of infected patients, pathogens were identified by skin biopsy alone.
  
  
  CONCLUSIONS
  Noninfectious causes accounted for a large proportion of new skin lesions in leukemia patients with suspected infections. Absence of neutropenia or fever did not rule out infection. Ulcerated or necrotic lesions and bacteremia or fungemia were independent predictors of infection. In the evaluation of patients with leukemia and new skin lesions, skin biopsy remains an important procedure to rule out infection, and is particularly useful for pathogen identification.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. dfarmakiotis@mdanderson.org
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakiotis
authors.forename: Ana Mercedes
authors.initials: AM
authors.lastname: Ciurea
authors.forename: Lizbeth
authors.initials: L
authors.lastname: Cahuayme-Zuniga
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D003141:Communicable Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology*; D055815:Young Adult
keywords: Cellulitis; Immunocompromised host; Leukemia; Rash; Skin biopsy; Sweet's syndrome