Cryopathic gangrene with an IgM lambda cryoprecipitating cold agglutinin

Kuenn, Jerry W.; Weber, Richard J.; Teague, Perry O.; Keitt, Alan S.

doi:10.1002/1097-0142(197810)42:4<1826::aid-cncr2820420422>3.0.co;2-x

Cited by 14 publications

(6 citation statements)

References 25 publications

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“…It is unclear if a relationship exists between these two disorders. A single antibody can have both cryoglobulinemic and cold agglutinin properties [23]. The antibody is usually an IgM lambda that lacks I specificity.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic multiple organ ischemia due to an anti‐Pr cold agglutinin developing in a patient with mixed cryoglobulinemia after treatment with rituximab

Ruch¹,

McMahon²,

Ramsey³

et al. 2008

American J Hematol

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Cold agglutinin disease occurring with cryoglobulinemia is a rare occurrence. Here, we report a patient with mixed cryoglobulinemia that was treated with rituximab and, after response, developed an anti‐Pr cold agglutinin that manifested with hemolysis and microvascular occlusion causing mesenteric ischemia and cerebral infarction. Unlike previous reports of patients with cryoglobulinemia and cold agglutinin disease, our patient did not have a detectable cryoprecipitate when his cold agglutinin manifested. Am. J. Hematol, 2009. © 2008 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Catastrophic multiple organ ischemia due to an anti‐Pr cold agglutinin developing in a patient with mixed cryoglobulinemia after treatment with rituximab

Ruch¹,

McMahon²,

Ramsey³

et al. 2008

American J Hematol

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“…5 Cutaneous necrosis is an exceptional complication of cold agglutinaemia, with only isolated cases reported in the world literature. 2,[4][5][6][7] Cutaneous lesions in cold agglutinaemia may appear on any part of the skin surface but acral areas such as exposed distal extremities, the tip of the nose and earlobes are the most commonly involved sites, probably related to the lower temperature in these areas. 1 Histologically, cold agglutinin disease causes extensive dilation of dermal vessels with thinning of the vascular walls and minimal perivascular cell infiltration.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous necrosis by cold agglutinins associated with glomeruloid reactive angioendotheliomatosis

Porras-Luque¹,

Fernández‐Herrera²,

Daudén³

et al. 1998

British Journal of Dermatology

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The cold agglutinin syndrome is a haemolytic disorder that can cause skin lesions, mainly on the acral areas, with acrocyanosis being the most frequent manifestation. Cutaneous necrosis due to cold agglutinins is very rare. Reactive angioendotheliomatosis (RAE) is an uncommon condition that exclusively affects the skin, characterized by a hyperplasia of endothelial cells and pericytes that can result in the formation of glomeruloid structures. The association of cold agglutinin syndrome with glomeruloid RAE has not been previously described. We report a 70-year-old man diagnosed as having a B-cell low-grade non-Hodgkin's lymphoma. He had two episodes of cutaneous necrosis in acral areas which were related to exposure to cold and due to IgM anti-I(T) cold agglutinins. Biopsy specimens showed vessel proliferations composed of dilated vascular spaces in the dermis and subcutis. Some vessel lumina were partially occluded by eosinophilic thrombi of fibrin and erythrocytes. Numerous closely packed capillaries were observed within pre-existing dilated vessels. This intravascular proliferation of capillaries displayed a glomeruloid pattern. We emphasize the possible presence of a cold agglutinin syndrome in patients with skin necrosis and findings of RAE with a glomeruloid pattern. Cold agglutinaemia may cause these distinctive histological changes.

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“…As agglutination is rapidly reversible on warming, almost never leading to permanent obstruction of blood vessels, gangrene is an exceptional manifestation of the cold agglutinin gangrene. 2,7,16 Up to 20% of community acquired pneumonia is caused by Mycoplasma pneumoniae and it is considered a major cause in cold agglutinin-positive pneumonic patients. 17,18,19 Secretion of peroxides by M. pneumoniae alters red cell antigens, which become immunogenic leading to the formation of immunoglobulin (Ig) M cold agglutinins.…”

Section: Discussionmentioning

confidence: 99%

“…Infectious diseases, such as those caused by Mycoplasma pneumoniae and Epstein-Barr virus, can present transient cold agglutinemia. [2][3][4][5][6][7] It usually causes reversible complications. Gangrene is an exceptional complication of cold agglutinemia, with isolated cases reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

Severe gangrene by cold agglutinemia

Vicari

Rodrigues

Figueiredo

2004

Rev. Bras. Hematol. Hemoter.

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The cold agglutinin syndrome is a haemolytic disorder usually manifested by acrocyanosis and Raynaud's phenomenon. Gangrene is an uncommon complication, usually associated with infections or B-cell lymphoproliferative diseases. We present a case of fulminant gangrene of fingers, toes, and nose in a 77-year-old woman with atypical pneumonia and acute renal failure. The diagnosis of haemolytic anaemia with cold agglutinin syndrome was done and the treatment with antibiotics and corticosteroids was effective. However, amputation of all the toes on both feet could not be avoided. Clinical aspects of cold agglutinemia, transient or chronic, are briefly discussed. We conclude that, in the presence of cold agglutinin syndrome, the treatment should be promptly initiated in order to avoid complications such as extensive gangrene.

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Cryopathic gangrene with an IgM lambda cryoprecipitating cold agglutinin

Cited by 14 publications

References 25 publications

Catastrophic multiple organ ischemia due to an anti‐Pr cold agglutinin developing in a patient with mixed cryoglobulinemia after treatment with rituximab

Catastrophic multiple organ ischemia due to an anti‐Pr cold agglutinin developing in a patient with mixed cryoglobulinemia after treatment with rituximab

Cutaneous necrosis by cold agglutinins associated with glomeruloid reactive angioendotheliomatosis

Severe gangrene by cold agglutinemia

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