Hyperglobulinemic Purpura in the Course of Multiple Myeloma

Abstract

Secondary hyperglobulinemic purpura of Waldenström is characterized by polyclonal gammopathy associated mainly with autoimmune diseases. Its occurrence with multiple myeloma is very rare. We describe a patient who developed characteristic lesions of hyperglobulinemic purpura in the course of IgA myeloma. Skin biopsy revealed deposition of IgA in the blood vessels.

Hypergammaglobulinemic purpura of Waldenström—Unusual and impressive case in a patient with myeloma: A case report

“…Two years prior to their admission, the patient also had an asymptomatic finding of IgA type lambda monoclonal gammopathy. 3 The patient presented in the current case report had been diagnosed with monoclonal gammopathy of undetermined significance approximately 5 years prior to her first similar episode of purpuric lesions. She was diagnosed with multiple myeloma 2 years later.…”

“…HGPW associated with myeloma is very rare with only several cases previously reported to our knowledge. 3–5 In a report by Savin, a patient had recurrent episodes of extensive self-resolving purpura involving the extremities prior to their diagnosis of myeloma. 5 Rogers and Welch described a male patient who had hypergammaglobulinemic purpura a decade prior to his diagnosis of myeloma.…”

“…Many cases are idiopathic, but associations include autoimmune, granulomatous, and hematological disorders as well as lymphoma and myeloma. 3–5,8 Therefore, screening for underlying disorders at the initial presentation of HGPW is important.…”

“…Many cases are idiopathic, but associations include autoimmune, granulomatous, and hematological disorders as well as lymphoma and myeloma. [3][4][5]8 Therefore, screening for underlying disorders at the initial presentation of HGPW is important. Henoch-Schonlein purpura 14 Lymphoma 8 Myeloma 3-5 Rheumatoid arthritis 6 Sarcoidosis [14][15][16][17] Sjögren's syndrome 6,7 Systemic lupus erythematosus 12,13 Tuberculosis 14,18…”

“…1 Sjögren syndrome is the commonest association; however, rare occurrences of lymphoma or myeloma have been reported. 1,3–8 A common link between these disease entities is polyclonal immunoglobin formation with immune complex deposits in blood vessels of the lower limbs. 1 The differential of HGPW includes non-inflammatory purpuras like pigmented purpuric dermatosis, as well as other forms of LCV.…”