Y leukemic cells, occurring in 5-20 of all leukemia instances.Bullousleukemiacutis(BLC)isanuncommon clinical subtype, connected with B-cell chronic lymphocyticleukemia(CLL).1,2Here,wedescribeapatient with CLL who created BLC and facial lesions that mimicked cellulitis. A67-year-oldwomanwithCLLwhohadbeen taking chlorambucil for the previous year created a periorbitalandmalaredemawitherythemaandwarmth, in spite of possessing no fever or discomfort (Figure 1). She was admitted to the dermatology ward and administered amoxicillin-clavulanate. Biochemical exams had been unremarkable as well as the hemogram showed leukocytosis (24200/mm3)withlymphocytosis(73.three ).Forty-eight hourslater,bullouslesionsemergedonthearms,legs, neckandface,whilenoimprovementwasobservedin thefacialedema(Figure2).Received on 13.03.2015 ApprovedbytheAdvisoryBoardandacceptedforpublicationon27.04.2015 * Operate performed at the Departamento de Dermatologia e Radioterapia da Faculdade de Medicina de Botucatu – Universidade Estadual Paulista “J io de MesquitaFilho”(Unesp) otucatu(SP),Brazil. Financial Assistance: None. ConflictofInterest:None.UniversidadeEstadualPaulista”J iodeMesquitaFilho”(Unesp) otucatu(SP),Brazil. 016byAnaisBrasileirosdeDermatologiaAn Bras Dermatol. 2016;91(2):248-9.sJuliana de Sousa Britto1 H ioAmanteMiotFigure 1: Bullous leukemia cutis mimicking facial cellulitis.DL-dithiothreitol Purity Periorbital and malar erythema and edemaBullous leukemia cutis mimicking facial cellulitis..Figure two: Bullous leukemia cutis. Various bullous lesions around the proper forearm and thumbHistopathology on facial and bullous lesions revealeddense,cutaneousinfiltrationbysmall,monomorphous,hyperchromaticlymphocytes.33235-31-3 Data Sheet Further,the immunohistochemistrystudywaspositiveforCD20, CD5,CD23,CD43andZAP-70.PMID:24367939 The patient underwent a chemotherapic regimen with five cycles of cyclophosphamide, prednisone,vincristineanddoxorubicin;fourrituximabcycleswerealsoadministered.Asnosignificantclinical improvement was noted, rituximab was combined with fludarabine and cyclophosphamide cycles, entailing gradual disappearance of cutaneous lesions despite the continued high bone marrow cellularity. CLL is definitely the most prevalent chronic leukemia in adulthood(3-5cases/100,000people)and90 ofcases take place after the age of 50.three Cutaneous lesions in CLL canbespecificornot.Sweet syndrome,herpeszos-ter,erythemanodosum,skininfections(bacterialand fungal),drugreactionsandinsectbitereactionshave been described.4 The hypothesized mechanism of cutaneous infiltration is definitely the migration of lymphocytes from the vasculature,mediatedbyintercellularadhesionmolecule-1(ICAM-1)andlymphocytefunction ssociated antigen-1(LFA-1).four Based on the pattern of cutaneous infiltration (epidermis, dermis or subcutaneous fat), leukemiacutiscanbecharacterizedbypapules,plaques, patches,purpuriclesions,nodules,bullaeorulcers.It canariseatanystageofdisease,althoughin5-18 of situations it could precede the diagnosis. Leukemia cutis can affect any cutaneous internet site but it manifests most usually aspapulesandnodulesontheface,chestandextremities. There isn’t any distinction in clinical patterns accordingtoleukemiatype,thougherythrodermiaandBLC are uncommon subtypes reported only in CLL; gingival hypertrophy,inacutemyeloidleukemia,andvesicles,in acute granulocytic leukemia.1,five Leukemia cutis is commonly linked with a far more aggressive illness and poor prognosis, except for CLL.1,4,six Conversely, our patient has immunophenotype ZAP-70 and has skilled incomplete diseaseremissionafterdifferentchemotherapyschemes, indicating a.