Cutaneous ulcers with type I cryoglobulinemia treated with plasmapheresis.
Severe necrotic cutaneous ulcers and kidney involvement secondary to type I cryoglobulinemia can be a therapeutic challenge. Plasmapheresis has been reported useful to treat autoimmune diseases such as thrombotic thrombocytopenic purpura, systemic lupus erythematosus, myasthenia gravis and Goodpasture's syndrome. We report the case of a patient who presented necrotic lesions with kidney involvement due to type I cryoglobulinemia (Ig G kappa) that evolved to a multiple myeloma. Treatment with high doses of corticosteroid plus cyclophosphamide did not control the disorder. Therapy with plasmapheresis produced a marked decrease in cryoglobulin levels and a subsequent relevant clinical improvement of cutaneous lesions and renal function. In cryoglobulinemia, plasmapheresis can be used as effective adjunt therapy to minimize cutaneous, renal and/or neurologic involvement.
Vila
A T
AT
Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Spain. avila@hsp.santpau.es
Barnadas
M A
MA
Ballarin
J
J
Garcia
R
R
Juarez
C
C
Madoz
P
P
Ramila
E
E
Alomar
A
A
D000368:Aged; D003449:Cryoglobulinemia / Q000150:complications* / Q000628:therapy; D003937:Diagnosis, Differential; D004431:Ear, External; D006801:Humans; D008297:Male; D010956:Plasmapheresis; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy; D012883:Skin Ulcer / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy