Extensive ecchymotic patch in a patient with chronic lymphocytic leukemia.

A 68-year-old female with a history of chronic lymphocytic leukemia (CLL) presented with an extensive purpuric patch on her left forearm. She had been treated with acalabrutinib for 5 months, and her white blood cell count had risen to 147 K/μl. Laboratory tests showed a platelet count of 152 K/μl and a hematocrit of 34.9%. A punch biopsy revealed vaso-occlusive changes and thrombotic vasculopathy. The patient's purpura resolved 6 weeks after discontinuing acalabrutinib. This case highlights the cutaneous manifestations of acalabrutinib toxicity and the need for monitoring and guidance for patients on BTK inhibitors. [Extracted from the article]