Bullous dermatosis and myeloma. Monoclonal anticytoplasmic antibody activity

Abstract

A case of a recurrent bullous eruption in a patient who had myeloma is reported. This eruption was differentiated from pemphigus and bullous pemphigoid by the histological and immunological findings. In addition, antibodies against the cytoplasm of basal cell layer cells in the human epidermis were detected in the patient's serum and in diseased skin. The myelomatous monoclonal protein and the antibody fixed on the cell cytoplasm had an identifical isotypical marker.

Cutaneous manifestations of multiple myeloma

“…[11] MM is rarely suspected from common skin disorders. Unusual presentations and nonresponsiveness to conventional therapy are important clues.…”

A case of multiple myeloma presenting as a bullous dermatosis

“…Skin involvement in MM is relatively rare 24. There have been reported cases of MM associated with dermatological disorders like pyoderma gangrenosum, Sweet's syndrome, erythema elevatum diutinum, panniculitis, necrobiotic xanthogranuloma, acquired cutis laxa, follicular hyperkeratosis, POEMS syndrome, telengiectasia macularis eruptiva perstans, toxic epidermal necrolysis, erythema multiforme, subcorneal pustular dermatosis, and Grover's disease 1–4…”

“…There are also reports that indicate the association of unusual bullous disorders and MM 45. In most of these cases, bullous dermatoses do not meet the histological and immunological criteria of known bullous disorders.…”

Multiple Hyperkeratotic Spicules and Myeloma

“…Monoclonal gammopathies and lymphoproliferative disorders are associated with a wide spectrum of cutaneous manifestation, including extramedullary cutaneous plasmacytomas, cutaneous amyloidosis, pyoderma gangraenosum [1, 2], leucocytoclastic vasculitis [3], necrobiotic xanthogranuloma [4, 5], scleromyxoedema [6], Sweet’s syndrome [7, 8], subcorneal pustular dermatosis [9, 10, 11, 12], POEMS syndrome [13, 14], scleroedema and plane xanthomas [15]. …”