Skin erythema with leukocytoclastic vasculitis and elastophagocytosis as the presenting features of an underlying myelodysplastic syndrome.

Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disease characterized by cytopenia, dysplasia in one or more of the major myeloid cell lines, ineffective hematopoiesis, and increased risk of development of acute myeloid leukemia [1]. The majority of patients with MDS present with symptoms related to cytopenia [1]. However, cutaneous manifestations have also been reported in patients with MDS [2, 3]. Different skin lesions have been documented, and are divided into specific and non-specific [2, 3]. Specific lesions are uncommon and characterized by the presence of neoplastic cells in the skin, which are referred to as leukemia cutis and indicate blastic transformation from MDS [4]. Non-specific lesions are common and include drug eruption and immunological impairment, such as infection or autoimmune diseases [2]. The most common skin lesions associated with MDS are Sweet’s syndrome and leukocytoclastic vasculitis [2, 3, 5].