title: Hemorrhagic Skin Nodules and Plaques: A Diagnostic Clue to Underlying Primary Plasma Cell Leukemia.
abstract: Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by a malignant proliferation of plasma cells (PC) in blood and marrow. Cutaneous involvement is very rare in PCL. We present the case of a 45-year-old lady who presented with multiple hemorrhagic nodules and plaques in the skin. Her total leucocyte count was 2,00,200/cmm with 85% abnormal plasmacytoid cells in peripheral smear. Biopsy of the skin lesions revealed diffuse infiltration by plasma cells with 'choked' blood vessels. A diagnosis of plasma cell leukemia with cutaneous involvement was made. On the second day of admission, the patient expired probably because of intracranial bleed due to thrombocytopenia. Post-mortem bone marrow and liver biopsy also showed diffuse infiltration by plasma cells. Monoclonality of the cells was proven by demonstrating the production of only kappa light chains.
authors.affiliation: Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Amiya Kumar
authors.initials: AK
authors.lastname: Nath
authors.affiliation: Department of Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Murugavel
authors.initials: M
authors.lastname: Subbian
authors.affiliation: Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Debdatta
authors.initials: D
authors.lastname: Basu
authors.affiliation: Department of Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Abdoul
authors.initials: A
authors.lastname: Hamide
authors.affiliation: Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Mariette
authors.initials: M
authors.lastname: D'Souza
keywords: Cutaneous hemorrhagic nodules; extramedullary involvement; plasma cell leukemia