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Case Reports: Unusual presentation of more common disease/injury
Painful ulcerations: the sole clinical sign of mixed cryoglobulinaemia secondary to marginal zone lymphoma
  1. Christian Gan1,
  2. Matthew David Howard1,
  3. Anthea Mulcahy1 and
  4. Anousha Yazdabadi1,2
  1. 1Dermatology, Box Hill Hospital, Box Hill, Victoria, Australia
  2. 2Melbourne University, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Anousha Yazdabadi; anoshay{at}unimelb.edu.au

Abstract

A man in his 70s with background vascular disease presented with 7 months of painful non-resolving lower leg ulcers with eschar and petechiae, left lower ear lobe ulceration and dusky inflammation of the right ear. He demonstrated good bilateral pedal pulses and no peripheral oedema. No lymphadenopathy was palpated.

Biopsy suggested leucocytoclastic vasculitis on chronic stasis changes. Blood investigations showed elevated rheumatoid factor and mixed polyclonal IgG and monoclonal IgM cryoglobulins. He was diagnosed with mixed cryoglobulinaemia, and consequent conducted flow cytometry revealed CD5 +marginal zone lymphoma with elevated serum free light chains and kappa/lambda ratio.

One-month following rituximab and chlorambucil therapy, the patient’s pain had much improved, ear ulcers had healed and several leg ulcers had reduced in width and depth. The petechial eruption had also resolved.

  • Dermatology
  • Skin
  • General practice / family medicine
  • Haematology (incl blood transfusion)

http://dx.doi.org/10.1136/bcr-2021-247780

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    Footnotes

    • Contributors CG carried out the writing of, and editing of the case report, as well as the research for the discussion. MDH and AM provided the clinical care for the patient as well as editing of the case report. AY provided consultant supervision and clinical care of the patient as well as reviewed the final manuscript of the case report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.