SHM Converge Scientific Abstract ePoster Gallery-More Than Skin Deep: A Systemic Cause of Leukocytoclastic Vasculitis

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This clinical vignette describes a 66-year-old man who presented with fevers, arthralgias, and fatigue in the setting of a recently diagnosed leukocytoclastic vasculitis (LCV) rash involving the skin. The rash was unusual because it was IgM/C3 positive and did not improve with steroids, raising concern for a systemic cause rather than typical self-limited LCV.<br /><br />Initial evaluation focused on infectious, autoimmune, and neurologic causes and was unrevealing: lumbar puncture studies were negative, broad infectious workup was negative, and autoimmune testing was negative. Inflammatory markers were elevated. Because of the patient’s persistent symptoms and steroid-refractory vasculitis, further workup was pursued.<br /><br />Subsequent testing revealed evidence of an underlying plasma cell disorder. Bone marrow biopsy showed 5–10% kappa-restricted plasma cells. Serum studies demonstrated an IgG kappa monoclonal protein with an M-spike of 0.4 g/dL, and cryoglobulin testing confirmed type I cryoglobulinemia. Imaging also found scattered lytic lesions, supporting the diagnosis of multiple myeloma.<br /><br />The final diagnosis was paraneoplastic type I cryoglobulinemia causing LCV secondary to IgG kappa multiple myeloma. The patient was treated with induction chemotherapy, followed by autologous hematopoietic stem cell transplantation. At six-month follow-up, the vasculitic rash had resolved and he had returned to baseline functional status.<br /><br />Key teaching points are that systemic symptoms in a patient with LCV—such as anemia, arthralgias, fatigue, or fever—should prompt evaluation for uncommon causes, including hematologic malignancy. Although LCV is usually benign and self-limited, rare cases can reflect type I cryoglobulinemia from a plasma cell dyscrasia. Treating the underlying malignancy can resolve the vasculitis.

Asset Subtitle

Austin M. Keller

Meta Tag

Author List Austin M. Keller, Constanza Menendez Alurralde, Marion v. Stanley, Niraj v. Lawande

Category Clinical Vignettes

Concept Leukocytoclastic Vasculitis

Concept Type I Cryoglobulinemia

Concept Multiple Myeloma

Concept Systemic Cause

Concept Malignancy

Distinguished Non-Finalist

Presenter Organization Northwestern University Feinberg School of Medicine - Department of Medicine

Presenting Author Austin M. Keller

Track Adult

Keywords

leukocytoclastic vasculitis

type I cryoglobulinemia

multiple myeloma

IgG kappa monoclonal protein

plasma cell dyscrasia

paraneoplastic vasculitis

steroid-refractory rash

lytic bone lesions

bone marrow biopsy

autologous stem cell transplantation

Leukocytoclastic Vasculitis

Type I Cryoglobulinemia

Multiple Myeloma

Systemic Cause

Malignancy