• Wei-Wei Ma, Lorna Martin Kasyanju Carrero, Xu-Feng Yin, Hou-Fang Liu, and Bing-Rong Zhou.
• Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
• Medicine (Baltimore). 2019 Aug 1; 98 (32): e16362e16362.

RationaleAtopic dermatitis (AD) is a chronic recurrent dermatitis with profound itching, which could be the first manifestation of acute myeloid leukemia (AML).Patient ConcernsA 53-year-old Chinese man suffered a 6-month history of systemic symmetrical dermatitis, accompanied with profound itching. The patient was diagnosed as "eczema" in several hospitals, and the effects of antihistamine and topical steroid creams were poor. Nocturnal sleep was seriously affected by aggravating pruritus. Laboratorial examination was compatible with AML-M4.DiagnosesAML-M4 with AD as first manifestation.InterventionsIA regimen (ayninen and cytarabine) were used in induction chemotherapy. However, the patient did not achieve complete remission, and although his rash had improved, he still experienced severely general body itching. On the seventh day of chemotherapy, the patient entered the period of granulocyte deficiency with infection.OutcomesThe patient died due to septic shock after chemotherapy.LessonsThe case strengthens the awareness of AML with AD as first manifestation and raises oncological vigilance in patients with AD refractory.

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