Korean J Med.  2013 Dec;85(6):634-638.

Gangrenous Cryoglobulinemic Vasculitis in a Patient with Multiple Myeloma

• Ryu H
• Park B
• Moon JY
• Lee MW
• Choi YS
• Song IC
• Jo DY

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.

Keyword

Cryoglobulinemia; Vasculitis; Multiple myeloma

MeSH Terms

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*
Dexamethasone
Immunoglobulin G
Thalidomide