J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website http://www.thejh.org

Case Report

Volume 7, Number 4, December 2018, pages 158-162

Vasculitis in Myelodysplastic Syndrome and Chronic Myelomonocytic Leukemia: A Report of Two Cases

Figure 2. Skin biopsy taken from the left lower leg of patient A. It shows epidermis, dermis and a medium-sized vessel in the upper subcutis. Small vessels (detail in box A) as well as medium-sized vessels (detail in box B) throughout the depth of the biopsy are circumferentially infiltrated by inflammatory cells, mainly lymphocytes. Endothelial cells are swollen and infiltrated by lymphocytes, narrowing the vessel lumen. There are no fibrinous thrombi or necrotic vessels. Affected vessels are surrounded by nuclear dust, erythrocytes and some eosinophils.

Figure 3. PET scan of patient B reveals an increased up-take of 18F-fludeoxyglucose in the ascending part and arch of the aorta.

**Table 1.** Laboratory Results of Patients A and B at Presentation
Range	Patient A	Patient B	Normal
*Female: 11.5 - 15.2 g/L, and male: 12.8 - 16.8 g/L.
ESR	96	132	< 30 mm/h
CRP	122	188	< 8 mg/L
Hb	10.2	9.1	*
Reticulocytes	45.6	37.6	25 - 120 × 10⁶/mL
MCV	100	107	83 - 100 fL
Leucocytes	3.1	12	4.0 - 10.0 × 10⁶/mL
Monocytes	0.2	4.3	0.2 - 0.9 × 10⁶/mL
Granulocytes	2.2	6.4	1.5 - 6.5 × 10⁶/mL
Platelets	76	210	150 - 400 × 10⁶/mL
Vit B12	193	570	148 - 550 pmol/L
Folic acid	39	18	6 - 30 nmol/L
Ferritin	1181	759	20 - 200 mg/L
Creatinine	62	62	50 - 95 mmol/L
LD	171	219	< 248 U/L
IgG	12.3	11.5	7.0 - 16.0 g/L
IgG4	ND	0.3	0.08 - 1.4 g/L
IgA	2.45	3.2	0.7 - 4.0 g/L
IgM	0.51	1.7	0.4 - 2.3 g/L
ANF	Positive	Negative	Negative
C3	1,430	1,430	900 - 1,800 mg/L
C4	223	189	150 - 400 mg/L
Anti-CCP	0.4	0.9	< 7.0 U/mL
Rheumatoid factor	< 0.4	1	< 5.0 IU/mL
Anti-dsDNA	0.8	1.9	< 10.0 IU/mL
Anti-ENA	0.4	0.2	< 0.7 ratio
MPO-ANCA	< 0.2	< 0.2	< 3.5 IU/mL
PR3-ANCA	< 0.2	< 0.2	< 2.0 IU/mL

Table 1. Laboratory Results of Patients A and B at Presentation

Range

Patient A

Patient B

Normal

*Female: 11.5 - 15.2 g/L, and male: 12.8 - 16.8 g/L.

ESR

132

< 30 mm/h

CRP

122

188

< 8 mg/L

10.2

9.1

Reticulocytes

45.6

37.6

25 - 120 × 10⁶/mL

MCV

100

107

83 - 100 fL

Leucocytes

3.1

4.0 - 10.0 × 10⁶/mL

Monocytes

0.2

4.3

0.2 - 0.9 × 10⁶/mL

Granulocytes

2.2

6.4

1.5 - 6.5 × 10⁶/mL

Platelets

210

150 - 400 × 10⁶/mL

Vit B12

193

570

148 - 550 pmol/L

Folic acid

6 - 30 nmol/L

Ferritin

1181

759

20 - 200 mg/L

Creatinine

50 - 95 mmol/L

171

219

< 248 U/L

IgG

12.3

11.5

7.0 - 16.0 g/L

IgG4

0.3

0.08 - 1.4 g/L

IgA

2.45

3.2

0.7 - 4.0 g/L

IgM

0.51

1.7

0.4 - 2.3 g/L

ANF

Positive

Negative

1,430

900 - 1,800 mg/L

223

189

150 - 400 mg/L

Anti-CCP

0.4

0.9

< 7.0 U/mL

Rheumatoid factor

< 0.4

< 5.0 IU/mL

Anti-dsDNA

0.8

1.9

< 10.0 IU/mL

Anti-ENA

0.4

0.2

< 0.7 ratio

MPO-ANCA

< 0.2

< 3.5 IU/mL

PR3-ANCA

< 0.2

< 2.0 IU/mL