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Toshihisa Hamada, MD; Hironori Matsuura, MD; Takashi Oono, MD; Shin Morizane, MD; Osamu Yamasaki, MD; Kenji Asagoe, MD; Takenobu Yamamoto, MD; Kazuhide Tsuji, MD; Keiji Iwatsuki, MD

Arch Dermatol. 2008;144(5):643-648.

Background  Recalcitrant pyodermic lesions and neutrophilic dermatoses are often associated with subclinical myelodysplastic syndrome (MDS). In this case series, we assessed the diagnostic importance of karyotypic analysis of bone marrow cells in 4 patients with MDS-associated pyodermic eruptions treated at our university hospital. Karyotypic analysis was performed in bone marrow cells and peripheral blood lymphocytes obtained. Serum levels of granulocyte colony-stimulating factor were measured.

Observations  Four patients with pyodermic eruptions or neutrophilic dermatosis had chromosomal abnormalities in bone marrow cells, including del(20)(q11;q13.3) in 2 patients, trisomy 8 in 1 patient, and t(11;22)(q23;q11) in 1 patient. Three patients without morphologic findings suggestive of MDS were diagnosed as having refractory anemia. One female patient had refractory anemia with ringed sideroblasts associated with del(20). Two patients with refractory anemia had a normal karyotype in peripheral blood lymphocytes. Two patients with elevated serum levels of granulocyte colony-stimulating factor had more active or widespread cutaneous diseases.

Conclusions  Karyotypic analysis of bone marrow cells, but not of peripheral blood lymphocytes, is essential in proving a diagnosis of MDS-associated pyodermic lesions. The overexpression of granulocyte colony-stimulating factor, which may compensate for impaired hematopoiesis in patients with MDS, seems to be a key cytokine leading to neutrophilic infiltration.

Author Affiliations: Departments of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama (Drs Hamada, Oono, Morizane, Yamasaki, Asagoe, Yamamoto, Tsuji, and Iwatsuki), and Kawasaki Medical University, Kurashiki (Dr Matsuura), Japan.

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