Paraneoplastic vasculitis associated with multiple myeloma

Abstract

The association between vasculitis and cancer has been widely reviewed in recent decades. The existence of malignancies in patients with vasculitis has been estimated at about 4.5-8%, haematological neoplasms being the most frequently observed. The haematological malignancies most frequently described are lymphoproliferative diseases such as hairy cell leukaemia and lymphomas. On the contrary, the incidence of paraneoplastic vasculitis in patients with myeloma is low; up to now, we have found nine cases reported on this subject. We report the case of a 73-year-old woman who in 1 year showed three outbreaks of acutely painful, purpuric and ulceronecrotic lesions, localized on the lower extremities. Histopathological study demonstrated thrombosis in the arterioles and leucocytoclastic vasculitis. Complementary tests revealed the presence of multiple myeloma.

Multiple myeloma with paraneoplastic leucocytoclastic vasculitis

“…Only about 11 cases of paraneoplastic cutaneous vasculitis associated with myeloma were reported so far. [3,4] Myeloma associated cutaneous vasculitis is mostly associated with IgA type but our case had Ig G type of myeloma. [3] Only two cases with predominantly ulceronecrotic lesions have been reported.…”

“…Systemic involvement was present only in two cases. [3] In our case the, vasculitis improved once treatment was started in our case but skin grafting was needed as the ulcers were large and deep. [2,5] This patient's skin biopsy …”

Metastatic Pulmonary Calcinosis and Leukocytoclastic Vasculitis in a Patient with Multiple Myeloma

“…Leukocytoclastic vasculitis rarely occurs during the course of multiple myeloma [2]. This vasculitis is an inflammatory necrotizing condition of the superficial dermal vessels, and is characterized by neutrophilic, angiocentric, segmental inflammation with endothelial cell injury and fibrinoid necrosis of the blood vessel walls [9].…”

“…Leukocytoclastic vasculitis is a systemic vasculitis characterized by involvement of small vessels in the skin that present as palpable purpura. It may present with systemic manifestations, such as fever, arthralgia as a finding of arthritis, and less commonly renal, neurological, and gastrointestinal functional compromise [2,3,4]. This disorder is related to hypersensitivity mechanisms caused by various antigens, primarily infections, drugs, or autoantigens in connective tissue diseases and malignant neoplasms [3].…”

Vasculitis de pequeño vaso en un paciente con un adenocarcinoma de colon

“…Además, los pacientes oncológicos pueden desarrollar durante la evolución vasculitis asociada al tumor o inducida por fármacos. En la literatura se han descrito vasculitis asociada principalmente a neoplasias linfoproliferativas aunque también con leucemias, mielomas y tumores no hematológicos como cáncer de riñón, nasofaringe, pulmón, próstata, mama y colon [2][3][4][5][6] . En otros casos se ha relacionado con el fár-maco administrado como gemcitabina, 5-fluorouracilo, tamoxifeno y después del transplante autólogo de médula ósea, mejorando tras la suspensión del citostático y la administración de metilprednisolona y/o ciclofosfamida [7][8][9] .…”