April 2014

Fig.1

Fig.2

 


HPI:  JM is a 35 year old man with a history of sclerotic plaques on his chest and abdomen for 2 years, diagnosed as morphea.  Four months prior to referral to this medical center, he suffered a severe sunburn to his legs while on a float trip.  Soon afterwards, he noted progressive sclerosis of the skin on his legs, hands, abdomen, and chest with decreased mobility in the ankles, wrists, and hands as well as pain in his legs.

PMHx:  None

Allergies:  None

Social history:  Truck driver, denies drinking or smoking

Family history:  Non-contributory

Medications:  Flexeril, Vicodin, Meloxicam

Labs: 

CBC:  WBC 18k, HGB 13.7, Plt 467, Diff:  N 42.8%, Lymph 11.6% Mono 4.6%, Eo 40.9% (absolute 7.4k)

Bone marrow biopsy:  hypercellular marrow with 30% eosinophils, 1% blasts.  Three lineages are present.  The differential includes reactive eosinophilia vs myeloproliferative disorder vs chronic eosinophilic leukemia.  PDGFR and FGFR testing is pending.

Physical exam:  Sclerotic, indurated plaque in the left upper chest represents the long standing lesion of morphea (figure 1).  Subsequent lesions developed on his abdomen (figure 1), with woody, yellow plaques developing along the anterior lower legs (figure 2).  Flexion contractures were noted at both ankles, and he has significant loss of functional mobility of his hands.

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