J Rheum Dis.  2013 Feb;20(1):44-47. 10.4078/jrd.2013.20.1.44.

Vasculitis as a Presenting Feature of Multiple Myeloma in a Patient with Rheumatoid Arthritis

• Son KM
• Kim JK
• Kim HA
• Park HR
• Park EJ
• Oh JM
• Seo YI

• KMID: 2223048
• DOI: http://doi.org/10.4078/jrd.2013.20.1.44

Abstract

Paraneoplastic vasculitis is a part of secondary vasculitis, the hematological neoplasm, such as lymphoma or myelodysplastic syndrome, which is most frequently observed. However, in multiple myeloma, cutaneous vasculitis is a rare complication, particularly as an initial clinical symptom. We report one case where a purplish reticulated patch on the lower extremity and an ear lobe skin necrotic change developed in a rheumatoid arthritis patient. He was diagnosed with multiple myeloma and cutaneous vasculitis.

Keyword

Vasculitis; Multiple myeloma; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid
Ear
Hematologic Neoplasms
Humans
Lower Extremity
Lymphoma
Multiple Myeloma
Myelodysplastic Syndromes
Skin
Vasculitis

Figure

• 

  Figure 1. (A) Purplish reticulated patches with dark red bullae on the lower extremities. (B) Black colored necrotic patches on the left ear.

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  Figure 2. BM aspiration: There are some plasma cells (arrow) with low nuclear/cytoplasmic ratio, deep basophilic blue cytoplasm, distinct clear area adjacent to the nucleus and eccentrically located nucleus (×1,000).

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  Figure 3. The histological features of skin biopsied specimen from knee (A, B) and ear (C, D). (A) Subepidermal cleft and dermal perivascular lymphocytic infiltration. (B) Eosinophilic crystals in deep dermis. (C) Subepidermal blister and dermal necrosis. (D) K light chain positivity in the intra-vascular eosinophilic crystals in the dermis.

Reference

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