Asymptomatic, Red-Brown Macules Symmetrically Distributed on Trunk and Arms of Adult Male: Challenge.

Abstract

CASE REPORT A 63-year-old Fitz IV man with a 3-year history of primary myelofibrosis presented to the dermatology clinic after referral by Heme/Onc for evaluation of new lesions on his trunk and upper extremities that had been increasing over the past several months. During a recent repeat bone marrow biopsy for disease activity monitoring of his myelofibrosis, decreased interval fibrosis was seen; however, new multifocal aggregates of .15 mast cells per high-power field were also visualized, of which greater than 25% exhibited a spindled morphology. A serum tryptase level was also significantly elevated to 268 mg/L (2.2–13.2 mg/L). Physical examination revealed numerous red-brown macules and patches with a background of prominent telangiectasias in a symmetric distribution on his bilateral flanks and arms (Figs. 1–3). Darier’s sign was negative.