title: Successful management of cryoglobulinemia-induced leukocytoclastic vasculitis with thalidomide in a patient with multiple myeloma.
abstract: Leukocytoclastic vasculitis (LV) is a systemic inflammatory disorder involving mostly the small vessels. It is characterised by segmental angiocentric neutrophilic inflammation, endothelial cell damage and fibrinoid necrosis. LV is related to a variety of clinical disorders including cryoglobulinemia and, very rarely, multiple myeloma (MM), among many others. The development of LV in patients with MM has been linked to cryoglobulinemia, infections, drugs and paraneoplasia. It has been speculated that myeloma patients with a poorer prognosis and progressive disease are more prone to develop LV. Thalidomide is a rediscovered old drug with anti-angiogenic, immunomodulatory and anti-inflammatory properties. It is highly effective in the treatment of MM and other clinical disorders such as leprosy, various cancers, graft-versus-host disease and autoimmune diseases. We report here a female patient with Durie-Salmon stage IIA MM who initially presented with cryoglobulinemia and LV. LV in this patient was primarily considered to be the result of progressive cryoglobulinemia, which was closely associated with MM. She was successfully managed with thalidomide and dexamethasone.
authors.affiliation: Department of Internal Medicine, Division of Haematology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. muhcar@superonline.com
authors.forename: M
authors.initials: M
authors.lastname: Cem Ar
authors.forename: Teoman
authors.initials: T
authors.lastname: Soysal
authors.forename: Gulen
authors.initials: G
authors.lastname: Hatemi
authors.forename: Ayse
authors.initials: A
authors.lastname: Salihoglu
authors.forename: Hasan
authors.initials: H
authors.lastname: Yazici
authors.forename: Birsen
authors.initials: B
authors.lastname: Ulku
mesh_terms: D003449:Cryoglobulinemia / Q000150:complications*; D003907:Dexamethasone / Q000627:therapeutic use; D019468:Disease Management; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy; D012074:Remission Induction; D013792:Thalidomide / Q000627:therapeutic use*; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000188:drug therapy* / Q000209:etiology
chemical_list: D013792:Thalidomide; D003907:Dexamethasone