Disseminated noninterstitial granulomatous dermatitis as a cutaneous manifestation of the preleukemic state in a patient with myelodysplasia and ulcerative colitis--apropos a case and review of the literature.

The authors describe a patient with a lesion on the right forearm. Her past medical history was significant for ulcerative colitis (UC, status post-colectomy six months prior). Eleven months earlier, she was diagnosed with myelodysplastic syndrome (MDS), a finding confirmed by bone marrow biopsy showing refractory anemia with excess blasts. The forearm lesion was biopsied. Within 2 weeks, the lesions spread to involve both arms. A month later, another lesion on the left elbow was biopsied. Histopathologic findings of both the biopsies revealed similar findings of multiple, superficial and deep, noncaseating granulomas. Including our case, the total number of reported cases of noninterstitial granulomatous dermatitis in a setting of MDS with impending leukemic transformation totals two. In contrast to the other, a confounding variable in ours was the history of UC. However, the development of the lesions after colectomy argued against them being a manifestation of UC. The authors present this case to increase awareness of the noninterstitial granulomatous dermatitis granulomatous reaction pattern as a possible histopathologic clue to the preleukemic state in a patient with MDS.