Published in:
01-01-2019 | Images
“Blueberry Muffin Spots” in an Adult Male Successfully Treated with Imatinib
Published in: Indian Journal of Hematology and Blood Transfusion | Issue 1/2019
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A 32-year-old male, known case of chronic myeloid leukemia (CML) on Imatinib with irregular compliance for 6 years, presented with painless swellings over the scalp, face and trunk for 3-weeks. He had non-tender, purplish nodules and plaques of varying sizes over the scalp, face and trunk giving “blueberry muffin” appearance (Fig. 1a). Hemoglobin was 8.3 g/dL; TLC 66,900/mm3 and platelets 70,000/mm3. Biopsy from skin nodule was suggestive of leukemia cutis (Fig. 2a, b). Bone marrow showed CML in chronic phase (Fig. 2c, d). Because of poor finances, he was counseled regarding compliance and imatinib dose was increased to 800 mg/day. Six weeks later, the complete hematological response was achieved, and skin lesions gradually resolved to hyperpigmented macules (Figure 1b).
Fig. 1
a Clinical photograph showing purplish nodules and plaques of varying sizes over face giving “blue berry muffin” appearance. b Clinical photograph after 3 weeks of TKI showing near complete resolution of facial lesions
Fig. 2
a Photomicrograph from the skin biopsy shows presence of leukaemic cells in the dermis (H&E × 20). b Photomicrograph shows leukaemic cells positive for CD34 (IHCX20). c Bone marrow aspirate smear shows markedly hypercellular marrow spaces with myeloid buldge (May Grunwald Giemsa × 400). d Bone marrow biopsy shows markedly hypercellular marrow spaces with granulocytic and megakaryocytic hyperplasia (Hematoxylin and eosin stain × 200)
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