SHM Converge Scientific Abstract ePoster Gallery-Acute Myeloid Leukemia Presenting as Treatment Resistant Atopic Dermatitis

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This case describes a 74-year-old man whose new-onset, severe, treatment-resistant “atopic dermatitis” on the palms and soles ultimately proved to be a cutaneous manifestation of acute myeloid leukemia (AML). Over the course of a year, he had persistent pruritic, hyperkeratotic, fissuring rash despite multiple therapies, including topical steroids, antifungals, tacrolimus, systemic steroids, phototherapy, and tralokinumab.  <br /><br />His skin disease was accompanied by progressive cytopenias, initially attributed to hepatitis C and infection, but never fully evaluated. On his final admission, he also had fevers and weight loss. Examination showed a hyperpigmented, hyperkeratotic rash with cellulitis of the right leg. Labs demonstrated marked leukocytosis with circulating blasts, anemia, and thrombocytopenia.  <br /><br />Bone marrow biopsy confirmed AML with monocytic differentiation. He was treated with azacitidine and venetoclax, and his rash nearly completely resolved within one month, supporting the conclusion that the dermatitis was paraneoplastic rather than primary atopic dermatitis.  <br /><br />The report emphasizes that adult-onset, severe, refractory eczematous dermatitis—especially when paired with unexplained cytopenias or systemic symptoms—should prompt reconsideration of the diagnosis and evaluation for underlying malignancy, including hematologic cancer.

Asset Subtitle

Lucy Z. Shi

Meta Tag

Author List Lucy Z. Shi, Swati Patki

Category Clinical Vignettes

Concept Eczema

Concept Acute Myeloid Leukemia

Concept Chronic Systemic Disease

Concept Malignancy

Concept Cytopenia

Distinguished Non-Finalist

Presenter Organization UC Davis School of Medicine

Presenting Author Lucy Z. Shi

Track Adult

Keywords

atopic dermatitis

acute myeloid leukemia

paraneoplastic dermatitis

refractory eczema

palms and soles

cytopenias

circulating blasts

bone marrow biopsy

azacitidine and venetoclax

hematologic malignancy

Eczema

Acute Myeloid Leukemia

Chronic Systemic Disease

Malignancy

Cytopenia