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TYPE I MONOCLONAL CRYOGLOBULINEMIA IgG KAPPA WITH SECONDARY VASCULITIS AS ONSET MANIFESTATION OF MULTIPLE MYELOMA
A 49-year-old patient initially admitted to the Rheumatology Clinic for arthralgias, swelling in the fists, knees and ankles, at a bilateral level, with RM>1h, dot-like necrotic lesions on the back side of his fingers and toes, extensive hemorrhagic lesions on the backside of his hands and feet, and, from a biological point of view, intense inflammatory syndrome and increased IgG are detected, so the patient was transferred to the Fundeni Hematology Clinic on the presumption of a monoclonal gammapathy diagnosis. The tests performed revealed IgG kappa monoclonal cryoglobulinemia and multiple myeloma stage IIIA. The skin biopsy confirmed the clinical suspicion of cryoglobulinemia vasculitis. The patient received bortezomib-based induction therapy with the multiple myeloma achieving complete remission and disappearance of rheumatoid syndrome/vasculitis. Subsequently, remission was consolidated with an autologous bone marrow transplant.
Rheumatoid syndrome and cryoglobulinemia vasculitis are rare onset manifestation in multiple myeloma. The association of multiple myeloma with symptomatic monoclonal cryoglobulinemia is an indication of chemotherapy and autologous bone marrow transplant, even in multiple myeloma stage I or II.
Keywords: rheumatoid syndrome, monoclonal cryoglobulinemia vasculitis, multiple myeloma, bortezomib, autologous bone marrow transplant