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Waldenström Macroglobulinemia–Induced Bullous Dermatosis
LTC Nadja Y. West, MC, USA;
James E. Fitzpatrick, MD;
LTC Kathleen M. David-Bajar, MC, USA;
COL Scott D. Bennion, MC, USA
Arch Dermatol. 1998;134:1127-1131.
Background Waldenström macroglobulinemia is a plasma cell dyscrasia of undetermined cause characterized by the monoclonal proliferation of lymphoplasmacytes in the bone marrow, lymph nodes, and spleen and elevated circulating levels and tissue deposition of monoclonal IgM produced by these aberrant cells. Rarely, cutaneous manifestations of this disease have been reported.
Observations We report the case of a patient with bullous dermatosis induced by Waldenström macroglobulinemia and demonstrate the subepidermal location of the separation and the presence of IgM and  light chains by immunoperoxidase, immunofluorescent techniques, and electron microscopy with immunogold staining. Immunoblotting revealed a strong band at the 290-kd area.
Conclusions The demonstration of the separation in the upper dermis at the site of IgM deposits suggests that these deposits may be an etiologic factor in this rare manifestation.
From the Dermatology Service, US Army Medical Activity, Heidelberg, Germany (Dr West); the Department of Dermatology, University of Colorado Health Sciences Center, Denver (Dr Fitzpatrick); the Dermatology Service, Brooke Army Medical Center, San Antonio, Tex (Dr David-Bajar); and the Medical Clinic, US Army Garrison Fitzsimons, Aurora, Colo (Dr Bennion).
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