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Cutaneous vasculitis as a presenting feature of multiple myeloma: A report of 2 cases

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Author(s): Kembre Priyam | Mahajan Sunanda | Kharkar Vidya | Khopkar Uday

Journal: Indian Journal of Dermatology, Venereology and Leprology
ISSN 0378-6323

Volume: 72;
Issue: 6;
Start page: 437;
Date: 2006;
Original page

Keywords: Leukocytoclastic vasculitis | Multiple myeloma | Palpable purpura

ABSTRACT
We report two male patients who presented with symmetrical, painful purpura that evolved into bullae and necrotic ulcers, predominantly on the extremities, over two months in spite of conventional therapy including oral steroids. Examination showed livedoid and purpuric patches with necrotic centers in starburst pattern over the extremities and buttocks. The first case also had similar lesions over the ears. The clinical presentation and the histopathological examination suggested a diagnosis of necrotizing leukocytoclastic vasculitis (LCV). Blood testing ruled out connective tissue disease, hepatitis B or C infection or streptococcal infection as underlying cause of vasculitis. Serum antinuclear factor, antineutrophilic cytoplasmic antibody and anticardiolipin anticoagulant were negative in both cases. Cryoglobulins were positive in case 2. An incidental finding was raised serum proteins and globulins in case 2. Further investigations revealed M band on electrophoresis and features of multiple myeloma on bone marrow biopsy in both cases. These cases emphasize the importance of simple investigations like serum proteins in the evaluation of LCV.
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