Light Chain Myeloma Precipitating Cryoglobulinemic Vasculitis.
Citation: Journal of Community Hospital Internal Medicine Perspectives. 13(1):42-47, 2023.PMID: 36817297Institution: MedStar Franklin Square Medical Center | MedStar Union Memorial HospitalDepartment: Hospitalist | PathologyForm of publication: Journal ArticleMedline article type(s): Case ReportsYear: 2023ISSN:- 2000-9666
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Multiple Myeloma (MM) is characterized by monoclonal immunoglobulin production leading to widespread skeletal destruction and renal dysfunction. Light chain multiple myeloma (LCMM) affects 15% of individuals with MM and has an overall poor prognosis. Cutaneous manifestations are uncommon and it is rarely complicated by Type I Cryoglobulinemia (CG). Here we present an atypical case of kappa-predominant LCMM complicated by Type I CG in an 80-year-old man who presented with a progressive non-blanching necrotic rash and ulcers involving his face, distal extremities, and oropharynx of two months duration prior to his admission at our facility. On admission to our facility, workup showed an overabundance of kappa-light chains, elevated free kappa/lambda ratio, cryoglobulins, and an acute kidney injury. Marrow biopsy demonstrated 60% plasma cells with kappa-light chain predominance. Cutaneous manifestations such as acral cyanosis and distal gangrene in LCMM indicate late stages of the disease, and such findings should raise suspicion for additional comorbid pathologies, including cryoglobulinemia, which could help direct earlier initiation of treatment. Copyright © 2023 Greater Baltimore Medical Center.
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