title: Multiple myeloma presenting as a novel mucocutaneous eruption.
abstract: A 71-year-old woman presented with exquisitely tender mucosal erosions, a diffuse polymorphous eruption, and night sweats. Workup revealed multiple myeloma with a monoclonal IgG-kappa paraprotein in the serum. Her severe oral involvement was suggestive of paraneoplastic pemphigus, but direct and indirect immunofluorescence tests were negative. A skin biopsy showed spongiosis and a sparse perivascular lymphocytic infiltrate, with occasional CD8-positive lymphocytes in the epidermis. Her lesions improved with intravenous immune globulin. Immunohistochemical staining on the formalin-fixed biopsy specimen was strongly positive for IgG and IgG-kappa in an epidermal "chicken-wire" pattern, but negative for IgG-lambda. Her pulmonary tissue stained negative for IgG-kappa, suggesting clinical relevance of the myeloma paraprotein in her epidermis. To our knowledge, this is the first report of a multiple myeloma patient with such an eruption.
authors.affiliation: University of California, San Diego, San Diego, California, USA. dlortscher@gmail.com
authors.forename: David N
authors.initials: DN
authors.lastname: Lortscher
authors.forename: Stan A
authors.initials: SA
authors.lastname: Amundson
authors.forename: Mark R
authors.initials: MR
authors.lastname: Pittelkow
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004817:Epidermis / Q000737:chemistry / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000032:analysis; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D052016:Mucositis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D009194:Myeloma Proteins / Q000032:analysis; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D010392:Pemphigus / Q000175:diagnosis; D011537:Pruritus / Q000209:etiology / Q000473:pathology / Q000628:therapy; D011649:Pulmonary Alveolar Proteinosis / Q000209:etiology; D017444:Skin Diseases, Papulosquamous / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D013546:Sweating; D015431:Weight Loss
chemical_list: D007145:Immunoglobulin kappa-Chains; D016756:Immunoglobulins, Intravenous; D009194:Myeloma Proteins