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In Reply Dr Alter raises the concern that the rationale for ordering a serum immunofixation electrophoresis was not explained. Alter presumes that immunofixation electrophoresis was ordered to evaluate the possibility of multiple myeloma. In fact, the immunofixation electrophoresis was ordered because scleredema has been described in association with a circulating paraprotein. Not all patients with paraproteinemia-associated scleredema have multiple myeloma.1- 3
Chatterjee S. Laboratory Testing in the Setting of Diabetic Scleredema—Reply. JAMA. 2016;316(5):543. doi:10.1001/jama.2016.6647