A 78-year-old white woman who had been diagnosed as having Waldenström macroglobulinemia (WM) 2 months earlier presented with a burning, tingling rash on the lower part of her legs. The diagnosis of WM was based on her immunophoretic pattern (showing a monoclonal IgM spike) and a bone marrow aspirate that demonstrated findings consistent with WM. She reported no systemic complaints, but noted some recent weight loss.
On physical examination, there were indurated, purplish papules scattered on the lower part of the legs (Figure 1), with purplish discoloration of the toes and feet. There were also 2 small ulcerations on the right leg and foot, and some scarring on the lower inner area of both legs, especially the right one. A punch biopsy specimen was obtained (Figure 2 and Figure 3).
Weinberg JM, Ioffreda M, White SM, Rudolph RI, Kramer EM. Purplish Papules on the Legs. Arch Dermatol. 2000;136(10):1263-1268. doi: