Clinical Features

Patients usually present with fatigue, weakness, weight loss and a history of repeated infections, and splenomegaly on physical examination. Lymphadenopathy is an inconsistent finding and may be observed in about 26% of patients (1). Specific skin lesions are considered to be uncommon in contrast to nonspecific skin lesions such as recurrent infections and ecchymoses (2,3). One or more cutaneous infections (including cellulitis, abscess, herpetic lesions, tinea, candidiasis, and verrucae) were observed in 47 of 113 (42%) patients (2). Infections are the most common cutaneous changes in HCL, accounting for approximately 60% of cases (4). Hairy-cell leukemia is also frequently associated with vasculitis (2,5). Specific skin lesions were seen in 48 (8%) of the 600 cases reported in the literature, but only eight cases were proven by skin biopsy (6). Patients usually present with multiple papules, pustules, or indurated plaques (Figs. 1 and 2). Deep infiltrated nodules may also be present. Lesions are most often located on the trunk and extremities. One patient had macrocheilitis mimicking Melkersson-Rosenthal syndrome that resulted from specific infiltration

Figure 1 Hairy-cell leukemia: Erythematous indurated plaques on the arm.

of the lips by HCL cells (7). In another puzzling case, a widespread specific skin eruption of HCL was transient, disappearing spontaneously (8).

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