case of rheumatoid arthritis complicated by a chronic myeloid leukemia associated with pyoderma gangrenosum

ABSTRACT

Rheumatoid arthritis may be associated with an increased risk of hematological malignancy. Increased lympho-proliferative malignancy in rheumatoid arthritis is often described; however an increased risk of leukemia is not a common rinding. A few cases of rheumatoid arthritis have been documented associated with chronic myeloid leukemia in the literature. We report a new case. A 36-year-old Moroccan female diagnosed as rheumatoid arthritis eight years ago, was on remission under Methotrexate and prednisone. This therapy was stopped one year before her admission at our hospital because of thrombopenia and anemia. She had polyarthritis flare. The physical examination found splenomegaly, hepatomegaly, and skin lesions at the trunk and limbs. Peripheral blood findings, peripheral smear and bone marrow aspiration diagnosed myeloid leukemia in a blastic accelerated phase with negative Philadelphia chromosome. The skin lesions were diagnosed as pyoderma gangrenosum [skin biopsy]. She received oral prednisone and chemotherapy [Cytarabine and 6-Mercaptopurine]. She had a complete response on the skin lesions, partial regression of splenomegaly, and improvement of her hematologic disorders. Unfortunately the patient died from septic shock after two weeks of post-chemotherapy pancytopenia. We report an unusual case of rheumatoid arthritis complicated by chronic myeloid leukemia associated with pyoderma gangrenosum. It is unclear whether the development of chronic myeloid leukemia in the patient with rheumatoid arthritis occurs by chance alone, is due to the underlying disease, or is facilitated by drugs. Whatever the cause is, it should be kept in mind that chronic myeloid leukemia may develop in the course of rheumatoid arthritis