# Relapsed Acute Myeloid Leukemia With Early Presentation As Leukemia Cutis, Refractory to Second-Line Treatment

## TL;DR

This paper presents a case of relapsed AML with early skin lesions (leukemia cutis) that did not respond to second-line treatment, highlighting the aggressive nature of the disease.

## Contribution

The case highlights leukemia cutis as a potential early marker of AML relapse and the need for novel treatment strategies.

## Key findings

- Leukemia cutis recurred early despite initial remission, indicating aggressive disease progression.
- The patient's condition deteriorated despite intensive treatment, showing refractory disease.
- The case emphasizes the importance of early recognition and multidisciplinary management for better outcomes.

## Abstract

Acute myeloid leukemia (AML) is a hematologic malignancy with a poor prognosis, often presenting with systemic and extramedullary manifestations. Leukemia cutis (LC), the infiltration of leukemic cells into the skin, is a rare and clinically significant complication of AML. It often signals extramedullary disease involvement, may precede systemic relapse, and is associated with poor survival outcomes. We report the case of a 36-year-old female with AML who developed recurrent, reddish-brown nodular skin lesions on the face, trunk, and extremities, consistent with LC. Despite achieving initial remission with induction and consolidation chemotherapy, she experienced early LC recurrence, pancytopenia, hepatobiliary dysfunction, and infectious complications, underscoring the aggressive nature of her disease progression. Disease progression was confirmed by bone marrow evaluation, which revealed 60% blasts. Despite intensive chemotherapy, antimicrobial prophylaxis, and granulocyte colony-stimulating factor support, the patient’s condition deteriorated due to refractory disease. This case suggests that LC may serve as a possible early marker of AML relapse, underscoring the importance of timely recognition and intervention. Multidisciplinary management and early diagnostic reassessment are essential to improving outcomes in such patients. Further research is needed to explore novel treatment strategies for AML patients with LC, aiming to enhance survival and disease control.