A 69-year-old male with a personal history of M1 AML, without differentiation, in complete remission (CR) 11 months after chemotherapy according to the PETHEMA-LAM protocol 99.
In February 2008, the patient was admitted for catarrhal respiratory symptoms, with significant nasal congestion and no response to antibiotics.
It also presents erythematous papules on the back, supraclavicular and submaxillary lymphadenopathy.
The patient is treated by a specialist red who presents two days of evolution without other ocular symptoms.
Her visual acuity was 20/20 in the RE and 18/20 in the LE.
Reflex, motility and ocular tone were within normal limits.
In the biomycosis of anterior pole a fleshy lesion of salmon color in the upper and lower tarsus was observed in the RE.
A similar lesion was found in the left lower tarsal conjunctiva.
No alterations were observed in the eye fundus.
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The possibility of leukemic involvement of the conjunctiva was considered and a biopsy of the lesion was performed.
In the histological study a diffuse proliferation of myeloid habit cells arranged under the conjunctival epithelium was observed, which showed immunohistochemical positivity for myelooperoxidase and CD43 case and CD203 granulocyte cell marker CD34 sarcoma.
1.
New biopsies confirmed the involvement of the nasal mucosa and skin.
With these findings the diagnosis was MS affecting the conjunctiva, skin and nasal mucosa.
However, no relapse was observed in peripheral blood smears and marrow, so it was considered that this level persisted in CR.
Lumbar puncture and other examinations were normal.
After the diagnosis of extramedullary recurrence in the form of MS of the AML, a second-line treatment was initiated according to the FLAG-IDA protocol with a good response of the lesions.
The patient died in May 2008, three months after the diagnosis of MS, due to multiple organ failure.
