A 68-year-old gentleman was evaluated for skin rashes over both legs and forearms for 2 months duration. On clinical examination, extensive confluent erythematous maculopapular rashes over both legs below knees and maculopapular rashes over both forearms was noted. Lab parameters revealed pancytopenia and macrocytosis. Vitamin B12 and folic acid levels were adequate. Bone marrow aspiration and trephine biopsy revealed trilineage dysplasia suggestive of MDS. Cytogenetic analysis by FISH ruled out abnormalities of chromosomes 5, 7, 8 and 20.
Skin rash biopsy was suggestive of leukocytoclastic vasculitis. Vasculitic work-up including p-ANCA and c-ANCA were negative. He was diagnosed as Myelodysplastic Syndrome (MDS) IPSS Intermediate-1 risk group with leukocytoclastic vasculitis. He was planned for DNA hypomethylating therapy with low dose Decitabine 20 mg/m2/day for 3 days. He received…
