Scedosporium apiospermum Soft Tissue Infection As the Initial Presentation of Acute Myeloid Leukemia: A Case Report

An 82-year-old woman presented with a nonhealing ulcer of her right leg as the first manifestation of acute leukemia. She had bumped her right leg while gardening and developed an ulcer that initially crusted but subsequently evolved a necrotic center. Several weeks later, the patient saw her primary care physician and was treated empirically with cephalexin and then trimethoprim and sulfamethoxazole with no improvement. She was found to have pancytopenia including severe neutropenia. Bone marrow aspirate (Fig 1A ) showed 93% blasts, and a biopsy (Figs 1B [low power] and 1C [high power]) demonstrated a markedly hypercellular marrow composed primarily of immature myeloid cells with a marked decrease in cells of erythroid and megakaryocytic lineages. A diagnosis of acute myeloid leukemia (AML), French-American-British type M0, was made. The marrow karyotype was normal, and a molecular analysis demonstrated wildtype FLT-3 and NPM-1.