title: Generalized livedo reticularis associated with monoclonal cryoglobulinemia and multiple myeloma.
abstract: Cryoglobulins are detected in a wide variety of diseases, including malignancies, infections and systemic autoimmune diseases. Classically, monoclonal cryoglobulinemia is associated with hematologic malignancies, whereas mixed cryoglobulinemias are reported in association with hepatitis C virus infections or autoimmune diseases. We present a patient with generalized livedo reticularis as the first manifestation of monoclonal cryoglobulinemia and multiple myeloma. Histopathology demonstrated that nearly all small blood vessels of the upper and deep dermis, as well as the capillaries of the fat lobule, were filled with homogeneous, eosinophilic material that corresponded to monoclonal cryoglobulin deposits within the vascular lumina. Our case of livedo reticularis associated with monoclonal cryoglobulinemia and multiple myeloma was exceptional, because the mottled cyanotic discoloration of the skin with a reticular pattern was generalized, covering most of the skin surface. We have not found previous report of similar cases. Therefore, we recommend that dermatologists be made aware of the significance of this diagnosis.
authors.affiliation: Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain. lrequena@fjd.es
authors.forename: Luis
authors.initials: L
authors.lastname: Requena
authors.forename: Heinz
authors.initials: H
authors.lastname: Kutzner
authors.forename: Jorge
authors.initials: J
authors.lastname: Angulo
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Renedo
mesh_terms: D001808:Blood Vessels / Q000378:metabolism / Q000473:pathology; D003449:Cryoglobulinemia / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D003450:Cryoglobulins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D010265:Paraproteinemias / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D010503:Periodic Acid-Schiff Reaction; D017445:Skin Diseases, Vascular / Q000150:complications / Q000378:metabolism / Q000473:pathology*
chemical_list: D003450:Cryoglobulins