Gangrenous Cryoglobulinemic Vasculitis in a Patient with Multiple Myeloma.
- Author:
Hyewon RYU
1
;
Bomi PARK
;
Ji Young MOON
;
Myung Won LEE
;
Yoon Seok CHOI
;
Ik Chan SONG
;
Deog Yeon JO
Author Information
1. Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea. deogyeon@cnu.ac.kr
- Publication Type:Case Report
- Keywords:
Cryoglobulinemia;
Vasculitis;
Multiple myeloma
- MeSH:
Biopsy;
Bone Marrow;
Cryoglobulinemia;
Dexamethasone;
Ear;
Female;
Fingers;
Gangrene;
Humans;
Immunoglobulin G;
Leg;
Livedo Reticularis;
Lower Extremity;
Middle Aged;
Multiple Myeloma*;
Paraproteinemias;
Plasmapheresis;
Skin;
Skin Ulcer;
Thalidomide;
Toes;
Ulcer;
Vasculitis*
- From:Korean Journal of Medicine
2013;85(6):634-638
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
We report a 62-year-old woman with multiple myeloma associated with cryoglobulinemia accompanied by gangrene of the digits. She presented with generalized purplish net-like discoloration (livedo reticularis), which was more prominent in the lower extremities. Multiple small shallow ulcers with crusts were found in places. In addition, gangrene was observed in both ear helices, both index fingers, and several toes. The patient had monoclonal gammopathy consisting of IgG and kappa (3.95 g/dL), cryoglobulinemia, and bone marrow plasmacytosis (42%). A biopsy of a discolored skin patch on the lower leg revealed leukocytoclastic vasculitis. She was diagnosed with multiple myeloma associated with cryoglobulinemia. Immediate plasmapheresis halted the progression of the skin lesions and digital gangrene. Two cycles of thalidomide plus dexamethasone therapy led to a partial response. This case highlights the need to search for cryoglobulinemia and multiple myeloma when we see livedo reticularis or multiple skin ulcers with obscure causes.
