Bullous pyoderma as a presentation of acute leukaemia

A patient with an unusual bullous pyoderma preceding the onset of acute leukaemia is reported. The initial lesions were purplish bullae, which later formed superficial ulcers and healed with minimal scarring. Histology showed intra-epidermal bullae with a dense polymorphonuclear infiltrate in the epidermis. This eruption is difficult to classify, but fifteen patients with similar skin lesions have been found in the literature, seven of these patients developed acute leukaemia and one had metastatic adenocarcinoma on presentation. We feel that the recognition of these distinctive skin lesions may be important because of their association with internal malignancy.