IgG Type Multiple Myeloma and Concurrent IgA Type Monoclonal Gammopathy of Undetermined Significance Complicated by Necrotizing Skin Ulcers due to Type I Cryoglobulinemia
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概要
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A 61-year-old male who worked as a frozen chicken processor was referred to us with necrotizing skin ulcers on his hands and feet. Serum IgG and IgA levels were 4,355 mg/dl and 605 mg/dl, respectively. Serum immunoelectrophoresis demonstrated M-bows for anti-IgGλ and anti-IgAκ. Bone marrow aspirate revealed approximately 31% atypical plasma cells. Cryoglobulin was identified in his serum. Cryoglobulin immunoelectrophoresis revealed monoclonal IgGλ paraproteins. The diagnosis was IgGλ type multiple myeloma and concurrent IgAκ type monoclonal gammopathy of undetermined significance with type I cryoglobulinemia. A skin biopsy taken from an involved site showed amorphous eosinophilic material occluding small vessel lumens. There was a good response after one cycle of chemotherapy consisting of vincristine, adriamycin and dexamethasone (VAD). There was a concurrent decrease in serum cryoglobulin levels ; this was associated with re-epithelialization of skin ulcers. Two years later, multiple myeloma progressed during a maintenance therapy of melphalan and prednisolone. Treatment with bortezomib following VAD resulted in a transient response. Serum IgG levels increased to 7,200 mg/dl, in contrast to a decrease in IgA levels to 7 mg/dl. The increase corresponded with the reappearance of skin ulcers. Shortly thereafter, the patient died of multiple myeloma. [J Clin Exp Hematopathol 50(1) : 71-74, 2010]
- 日本リンパ網内系学会の論文
- 2010-05-01
著者
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MORIWAKI H.
Gifu University School of Medicine
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MORIWAKI Hisataka
First Department of Internal Medicine, Gifu University School of Medicine
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Moriwaki H
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Moriwaki Hisataka
岐阜大学 医学部内科学
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Moriwaki Hisataka
がん・感染症センター都立駒込病院 肝臓内科
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Moriwaki Hisataka
Dep. Of Gastroenterology Gifu Univ. School Of Medicine
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Moriwaki Hisataka
東京大学医科学研究所
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Fukuno Kenji
高山赤十字病院 内科
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Fukuno Kenji
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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TSURUMI HISASHI
First Department of Internal Medicine, Gifu University Hospital
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GOTO NAOE
First Department of Internal Medicine, Gifu University School of Medicine
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KANEMURA NOBUHIRO
First Department of Internal Medicine, Gifu University School of Medicine
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Yamada Toshiki
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Yoshikawa T
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Mohri Hiromi
1st Department Of Internal Medicine Gifu University School Of Medicine
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Takao Hiroshi
Second Department Of Surgery Gifu University School Of Medicine
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Moriwaki Hisataka
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Kanemura Nobuhiro
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Goto Naoe
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Yoshikawa Takeshi
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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KASAHARA Senji
First Department of Internal Medicine, Gifu University Graduate School of Medicine
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Tsurumi Hisashi
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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NINOMIYA Soranobu
First Department of Internal Medicine, Gifu University Graduate School of Medicine
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Kasahara Senji
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Yamada Tetsuya
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Moriwaki H
Gifu Univ. School Of Medicine Gifu Jpn
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Moriwaki H.
First Department Of Internal Medicine Gifu University School Of Medicine
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Tsurumi Hisashi
Department Of Medicine Gifu University School Of Medicine
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Moriwaki H.
Department Of Internal Medicine Gifu University
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Ninomiya Soranobu
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Moriwaki Hisataka
Department Of Medicine Gifu University Graduate School Of Medicine
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