A patient with chronic myelomonocytic leukemia (CMML) may present with chilblains (pernio) or complaints of being hypersensitive to cold. This may be the first indication of the underlying hematologic disorder.
Features:
(1) Most patients will be elderly but it could occur in a younger patient with a juvenile myelomonocytic leukemia (JMML).
(2) The patient is known to have a myeloproliferative disorder or has an elevated white blood cell count with monocytosis.
(3) Other causes of chilblains (cold agglutinin, Raynaud's, etc) are excluded.
(4) Symptoms will tend to be worse with higher white blood cell counts and improve when the WBC count is lower.
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