Skin manifestation of a systemic disease

Abstract

Skin manifestations can be the first indication of an underlying systemic disease, such as neoplasia, autoimmune disorders, or infections. It is crucial to remain vigilant in identifying and considering less common diagnostic hypotheses, enabling the prompt exclusion of uncommon and potentially life-threatening conditions.

We report a case of a 51-year-old man who presented with a lesion on the back of his left hand, generalized weakness, a feverish feeling. Laboratory analysis revealed severe pancytopenia. Both infectious and autoimmune causes were excluded. Further investigation with myelogram and bone biopsy revealed bone marrow infiltration by 80% hairy cell leukocytes, with immunophenotyping confirming a diagnosis of hairy cell leukemia (HCL). The patient required alternative treatment due to testing positive for SARS-CoV-2 during hospitalization.

This case is particularly noteworthy as most patients with HCL are asymptomatic at diagnosis, also skin changes in pancytopenic patients are uncommon.