Nobuhiko Higashi

Allergic contact dermatitis due to diclofenac and indomethacin.

14. Sinigaglia F. The molecular basis of metal recognition by T cells. J Invest Dermatol 1994: 102: 398–401. 15. Emtestam L, Olerup O. On T-cell recognition of nickel as a hapten. Acta Dermato-venereologica 1996: 76: 344–347. 16. Bour H, Nicolas J F, Garrigue J L et al. Establishment of nickel-specific T cell lines from patients with allergic contact dermatitis. Clin Immunol Immunopathol 1994: 73: 142–145. 17. Griem P, Panthel K, Kalbacher H, Gleichmann E. Alteration of a model antigen by Au (III) leads to T-cell sensitization to cryptic peptides. Eur J Immunol 1996: 26: 279–287. 18. Goebel C, Kubicka-Muranyi M, Tonn T et al. Phagocytes render chemicals immunogenic: oxidation of gold (I) to the T cell-sensitizing gold (III) metabolite generated by mononuclear phagocytes. Arch Toxicol 1995: 69: 450–459. 19. Griem P, Gleichmann E. The antirheumatic drug gold: de-

Cutaneous infiltration in acute promyelocytic leukemia

The incidence of leukemia cuffs varies from 2% to 20% in patients with lymphocytic (excluding Tcell derived) and granulocytic leukemia and from 10% to 50% for patients with monocytic leukemia. 1 The incidence of leukemia cuffs in patients with acute promyelocytic leukemia (APL) appears to be low. Indeed, two recent articles describing a total of 137 patients with APL did not report any case of leukemia cutis. 2, 3 APL is a distinct subtype of acute myelogeneous leukemia with characteristic clinical and molecular features. 4 A genetic feature is a 15:17 chromosomal translocation involving the PML gene on chromosome 15 and the retinoic acid receptor oL (RARo0 gene on chromosome 17. 5 Recently, all-trans retinoic acid (ATRA) has been shown to induce complete clinical remission in a high proportion of patients with APL by promoting differenffation of the malignant cells into phenotypically mature myeloid cells. 6 However, treatment also creates a unique pattern of adverse events, including leukocytosis and retinoic acid syndrome. 7 We describe a patient with APL treated with ATRA who had leukemia cuffs at the time of a complete hematologic remission. CASE REPORT