Waldenström macroglobulinaemia presenting as tingling ulcers on the feet

Fischer, Isabelle; Dyall‐Smith, Delwyn; Peters, Birgit; Stolz, Wilhelm; Coras-Stepanek, Brigitte

doi:10.5826/dpc.0303a03

Dermatol Pract Concept

2013

DOI: 10.5826/dpc.0303a03

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Waldenström macroglobulinaemia presenting as tingling ulcers on the feet

Isabelle Fischer

Delwyn Dyall‐Smith

Birgit Peters

et al.

Abstract: A 56-year-old man presented with tingling ulcers on the feet. On further skin examination, papules on the knees were observed. Biopsies revealed extravascular eosinophilic deposits of IgM, and Waldenström macroglobulinaemia was diagnosed. The skin manifestations have resolved with chemotherapy. Peripheral neuropathy and storage papules are rare manifestations of Waldenström’s macroglobulinaemia.

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“…To our knowledge, only four previous cases of hyperkeratotic lesions on the soles associated with WM have been reported . The reasons why papules are more common on the limbs, especially on the extensor surfaces is unknown; however, we hypothesized that slower venous return and minor trauma may play important roles.…”

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Multiple verrucous lesions of the feet in Waldenström macroglobulinaemia

et al. 2017

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A 59-year-old woman presented with a 4-month history of papules on the soles of her feet. She also reported having received cat-flea bites on her lower legs 4 months previously. The patient was otherwise well. The plantar lesions were slightly tender, and had been treated with topical treatments of vitamin D3 and salicylic acid, without improvement.Physical examination revealed hyperkeratotic papules and plaques on both soles, and red-brown papules on the dorsa of the feet and ankles (Fig. 1).Histological examination of a skin biopsy taken from the plantar papules showed eosinophilic amorphous deposits in the dermis, which stained positive with periodic-acid-Schiff but negative with Congo red (Fig. 2), while immunohistochemistry showed that they were positive for IgM.Laboratory tests showed the following results: haemoglobin 12.2 g/dL (normal range, 11.6-14.8 g/dL), total serum protein 8.6 g/dL (normal range 6.6-8.1 g/dL), albumin : globulin ratio 1.0 (normal range 1.32-2.23), serum IgM 3012 mg/dL (normal range 50-269 mg/ dL). A monoclonal M band in the gamma region was seen by by immunoelectrophoresis. Bone marrow biopsy revealed a proliferation of lymphoplasmacytic cells occupying 20-30% of the nucleated cells, which were partly positive for CD20, with clonal reaction to IgM and kappa chain.Computed tomography of the chest and abdomen was normal.Based on the clinical, laboratory and histological findings, a diagnosis of Waldenstr€ om macroglobulinaemia (WM) with cutaneous macroglobulinosis was made. The haematologists recommended that no therapy was required.WM is a lymphoplasmacytic lymphoma associated with excess production of monoclonal IgM, and can present with a wide variety of symptoms. Skin lesions occur in approximately 5% of patients with WM. 1,2Cutaneous macroglobulinosis is a very rare dermatological manifestation of WM, which is characterized by

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confidence: 96%

“…WM is a lymphoplasmacytic lymphoma associated with excess production of monoclonal IgM, and can present with a wide variety of symptoms. Skin lesions occur in approximately 5% of patients with WM . Cutaneous macroglobulinosis is a very rare dermatological manifestation of WM, which is characterized by IgM deposition in the skin.…”

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Multiple verrucous lesions of the feet in Waldenström macroglobulinaemia

et al. 2017

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Paraprotein deposits in the skin

Alegría-Landa

Cerroni

Kutzner

et al. 2017

Journal of the American Academy of Dermatology

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Waldenström macroglobulinaemia presenting as tingling ulcers on the feet

Cited by 2 publications

References 4 publications

Multiple verrucous lesions of the feet in Waldenström macroglobulinaemia

Multiple verrucous lesions of the feet in Waldenström macroglobulinaemia

Paraprotein deposits in the skin

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