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Date
2022-07-01
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Abstract
A 7‐year‐old girl with no past medical history presented to the local paediatric department with a 3‐month history of a rapidly enlarging nodular lesion on the central scalp associated with central crusting and hair loss. Four weeks previously the patient had been started on oral terbinafine for a presumed kerion. Further examination by the paediatric team demonstrated no further skin lesions, but examination of her neck revealed tender right‐sided cervical lymphadenopathy. Full blood count demonstrated marked eosinophilia at 48 × 109 cells L–1 (normal range 0·10–0·40 × 109 cells L–1). Owing to the clinical findings and lack of response to treatment a biopsy of the scalp lesion and cervical nodes were undertaken. Biopsy of both scalp lesion and cervical lymph node demonstrated extensive diffuse infiltration of the dermis by small‐to‐medium round, blue cells consistent with lymphoblasts. Immunostaining showed the cells to be uniformly CD19, PAX5, TdT and CD10 positive, and CD20 weakly patchy positive. Flow cytometry confirmed B‐cell acute lymphoblastic leukaemia (B‐cell ALL). The patient was referred to our local tertiary paediatric oncology centre for induction chemotherapy as per the UK ALL guidelines 2019. We believe that this case is unique as it is the first time a child with B‐cell ALL has presented with leukaemia cutis. It is a rare cutaneous finding in this type of ALL, usually developing subsequently to systemic disease.
Citation
Moss, J. Takwale, A. and Craig, P. BH08: A rare cause of hair loss in a child. (2022). British Journal of Dermatology, 187(S1), 100. https://doi.org/10.1111/bjd.21336