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PP-088 Neonatal acute leukemia presenting with skin involvement
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  1. Salih Çağrı Çakır1,
  2. Funda Aydemir1,
  3. Yasemin Alyay2,
  4. Kevser Üstün Elmas1,
  5. Melike Sezgin Evim3,
  6. Hilal Özkan1,
  7. Adalet Meral Güneş3,
  8. Nilgün Köksal1
  1. 1Division of Neonatology, Department of Pediatrics, Bursa Uludag University Faculty of Medicine
  2. 2Department of Pediatrics, Bursa Uludag University Faculty of Medicine
  3. 3Division of Pediatric Hematology, Department of Pediatrics, Bursa Uludag University Faculty of Medicine

Abstract

Aim Neonatal leukemia is a rare disease with an incidence rate of 1–5 per 1000000 live births. Leukemia cutis occurs in 25–30% of infants with leukemia. Neonatal leukemia cutis presents within the first four weeks of life. It often has a ‘blueberry muffin baby’ appearance of magenta-colored nodules affecting almost any skin area. Here, a case of neonatal leukemia with blueberry muffin was presented due to its rarity.

Material and Method We report a 20-day-old male baby with a blueberry muffin appearance and decreased activity. He was born at 39 weeks gestation by cesarean section as APGAR of 8–10 and a weight of 4020 g from a 25-year-old gravida 1 mother. The patient had no additional features in his medical and family history. Physical examination revealed a weight of 4020 g (50–90p), a height of 52 cm (50–90p), a head circumference of 37 cm (90p), blueberry muffin rash (figure 1) on the trunk and proximal extremities, hepatosplenomegaly. Laboratory studies revealed a white blood cell count of 1048x109/L, hemoglobin of 8.5 g/dL, and platelet count of 49.6x109/L. Diffuse blastic cells were observed in the microscopic examination of the peripheral blood smear.

Abstract PP-088 Figure 1

Blueberry muffin.

Results Erythrocyte and platelet transfusions were performed. The patient underwent leukapheresis once, and the white blood cell count was reduced to 325x109/L. The B-acute lymphoblastic leukemia was detected in the patient according to diagnostic tests. The 11q23 translocation was detected positive in the genetic tests. The patient was started on a chemotherapy protocol. The patient, who did not respond adequately to chemotherapy and developed septic shock and respiratory distress during follow-up, died at the age of 55 days.

Conclusions Congenital leukemia is a disease that is rare in the first month of life and has a poor prognosis. Skin lesions can often be the initial symptom. Skin findings in infancy should be evaluated from this perspective.

  • blueberry muffin syndrome
  • congenital leukemia
  • newborn
  • leukapheresis
  • hyperleukocytosis

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