Images in Clinical Medicine

Gangrene and Type I Cryoglobulinemia in Multiple Myeloma

Lorenzo Cirasino, M.D., and Pier Remigio Barbano, M.D.

N Engl J Med 1999; 341:1582November 18, 1999

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Figure 1 A 57-year-old woman was admitted because of ischemia of the feet (Panel A). A monoclonal IgG- λ gammopathy and type I cryoglobulinemia (cryocrit, 13.8 percent) were found in the serum, and a bone marrow biopsy revealed multiple myeloma with plasmablastic features (inset; Giemsa, ×1000). Gangrene developed, with subsequent mummification of the left foot (Panel B), despite treatment with intensive plasmapheresis, epoprostenol, and vincristine, doxorubicin, and dexamethasone. A conservative amputation was carried out after the completion of six cycles of chemotherapy. After the chemotherapy, the cryoglobulins disappeared from serum (cryocrit, 0), but the myeloma persisted in the bone marrow.

Lorenzo Cirasino, M.D.
Pier Remigio Barbano, M.D.
Niguarda Ca' Granda Hospital, 20162 Milan, Italy

Citing Articles (3)

Citing Articles

1. 1

   A. Duval, O. Moranne, P. Vanhille, E. Hachulla, E. Delaporte. (2006) Artériolopathie calcique (Calciphylaxie). La Revue de Médecine Interne 27:3, 184-195
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2. 2

   Amir Modarressi, Mercy Kuriyan, Gail Harvey, Roger Strair. (2003) Heat insoluble cryoglobulin associated with gangrene in multiple myeloma. Journal of Clinical Apheresis 18:4, 190-193
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3. 3

   G. Litscher, L. Wang, G. Nilsson. (2001) Laser Doppler Imaging und Kryoglobulinämie - Laser Doppler Imaging and Cryoglobulinaemia. Biomedizinische Technik/Biomedical Engineering 46:6, 154-157
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