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WWW.MDEDGE.COM/DERMATOLOGY A woman in her seventies presented with a painful rash of 3 months’ duration, as well as fever, diaphoresis, and arthralgia of 3 weeks’ duration. The rash first appeared on the trunk with centrifugal spread to the face, arms, legs, palms, and soles. The patient had a 16-year history of untreated chronic lymphocytic leukemia, type 2 diabetes mellitus, and hypertension. Physical examination revealed reddish brown, edematous and indurated, coalescing, circular, 1to 1.5-cm plaques on the face (leading to mild leonine facies), upper back, posterior thighs (top), buttocks (bottom), and palms. The arms, legs, abdomen, and chest also were involved to a lesser extent. The skin was diffusely tender to palpation with no accentuation over the lesions. There was no associated pruritus or lymphadenopathy. The patient was febrile (temperature, 38.4°C). A complete blood cell count with differential and liver function tests were within reference range on laboratory evaluation. Blood cultures were negative for both bacterial and fungal infections and finalized after 5 days. Polymerase chain reaction for ehrlichiosis was negative, and histoplasma and cryptococcal antigens were not detected. Computed tomography revealed a hepatic mass, splenomegaly, diffuse adenopathy, and bilateral pulmonary nodules but no parenchymal disease. Skin biopsies were obtained from the left forearm and forehead. Samples were sent to the National Hansen’s Disease (Leprosy) Program given concern for Hansen disease based on her husband’s history of prior employment in a leprosy hospital.

Diffuse Painful Plaques in the Setting of Chronic Lymphocytic Leukemia