Acute Leukemia the Imitator!

Acute leukaemia can infiltrate various organs with atypical manifestation posing a diagnostic dilemma. We describe one such case of acute myeloid leukaemia presenting with predominant skin and renal manifestations. A 55 years old female presented with intermittent fever, painful purpuric rash over the limbs and abdomen resembling vasculitis. Further, her renal biopsy showed features of IgA nephropathy. However, when her symptoms recurred despite treatment, the repeat blood smear showed Leucocytosis with predominant monocytes along with immature monocytes and severe thrombocytopenia. Subsequent bone marrow study was diagnostic of Acute myeloid leukaemia. She was initiated on chemotherapy and has been doing well. IgA Nephropathy associated with leukaemia and lymphoma is a very rare entity making this case noteworthy. Another highlight of this case is the Cutaneous manifestation of acute myeloid leukaemia - leukaemia cutis which was the presenting complaint in our patient. The presence of Leukaemia cutis generally suggests that there are other sites of extramedullary involvement, thereby indicating a poorer prognosis.