A 72-year-old woman, who was otherwise healthy, developed a painful ulceration on her right lower extremity after minor trauma. The ulcer started as a small pustule on her right leg and rapidly evolved into a painful ulcer. Initial investigation revealed normal laboratory test results with the exception of an elevated white blood cell count (66.0 × 103/µL [reference range, 4.5-11.0 × 103/µL]). Subsequent workup revealed chronic myelomonocytic leukemia, with multiple complex cytogenetic findings, including a 5q– mutation and an absence of the Philadelphia chromosome. Before her hospitalization, the patient underwent surgical debridement, which led to rapid progression of her ulcer and aggravation of her pain.
Srivastava M, Rencic A, Nousari HC. A Rapidly Expanding Ulcer—Quiz Case. Arch Dermatol. 2003;139(4):531-536. doi:10.1001/archderm.139.4.531-a