Multiple myeloma presenting as a novel mucocutaneous eruption
David N Lortscher1, Stan A Amundson, Mark R Pittelkow
1University of California, San Diego, San Diego, California, USA. dlortscher@gmail.com
Dermatology Online Journal
|January 5, 2011
Summary
This study reports a rare case of multiple myeloma presenting with skin and mucosal lesions. Immunohistochemistry confirmed epidermal deposition of the patient's specific IgG-kappa paraprotein, suggesting a novel paraneoplastic manifestation.
Area of Science:
- Dermatology
- Oncology
- Immunology
Background:
- Multiple myeloma is a plasma cell malignancy.
- Paraneoplastic syndromes can manifest with various skin and mucosal findings.
- Distinguishing paraneoplastic pemphigus from other dermatoses is crucial for diagnosis and management.
Observation:
- A 71-year-old woman presented with painful mucosal erosions, a widespread eruption, and night sweats.
- Diagnostic workup revealed multiple myeloma with a monoclonal IgG-kappa paraprotein.
- Initial immunofluorescence tests for paraneoplastic pemphigus were negative, but skin biopsy showed epidermal changes.
Findings:
- Immunohistochemical staining of the skin biopsy revealed a characteristic "chicken-wire" pattern of IgG and IgG-kappa deposition in the epidermis.
- This epidermal deposition correlated with the patient's specific myeloma paraprotein.
- Pulmonary tissue did not show IgG-kappa deposition, localizing the phenomenon to the skin.
Implications:
- This case suggests a potential novel cutaneous manifestation of multiple myeloma.
- The findings highlight the importance of considering specific paraprotein deposition in the skin for diagnosing unusual paraneoplastic syndromes.
- Further research is warranted to understand the mechanisms underlying this association and its clinical relevance.
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