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Follicular Spicules of the Nose and Ears—Diagnosis
Arch Dermatol. 2009;145(4):479-484.
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Diagnosis: Follicular cutaneous spicules and necrotizing livedo in multiple myeloma with monoclonal (type I) cryoglobulinemia.
MICROSCOPIC FINDINGS AND CLINICAL COURSE
Histopathologic examination of the skin biopsy specimen from the upper back area demonstrated follicular plugs of compact homogeneous eosinophilic material protruding from the epidermis, with no significant inflammatory infiltrate. Direct immunofluorescence staining detected IgG in the follicular plugs. A skin biopsy specimen from an area of necrotizing purpura revealed multiple thrombi of compact eosinophilic material in dilated capillaries in the upper dermis but no vasculitis, features that were consistent with thrombotic vasculopathy caused by cryoglobulinemia. Spicules from the nose were removed by gentle curretage and biochemically shown to be cryoprecipitates of monoclonal IgG- with electrophoretic characteristics identical to those of paraprotein and cryoprecipitates that were detected in serum and urine samples from the patient. A subsequent bone marrow biopsy revealed a hypercellular marrow with heavy infiltration of plasma cells (75%). These findings were consistent with the diagnosis of multiple myeloma with localized necrotizing livedo due to cryoglobulinemia and characteristic follicular . . . [Full Text of this Article] DISCUSSION
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Arch Dermatol. 2009;145(4):479-484.
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