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February 1991

Atrophie Blanche in a Patient With ?—Heavy-Chain Disease

Author Affiliations

Department of Medicine; Department of Dermatology Yale University School of Medicine 333 Cedar St New Haven, CT 06510; Department of Medicine Memorial Sloan-Kettering Cancer Center 1275 York Ave New York, NY 10021

Arch Dermatol. 1991;127(2):272-273. doi:10.1001/archderm.1991.01680020144031

To the Editor.—  Atrophie blanche (livedoid vasculitis) is characterized by purpura and painful ulcerations of the lower extremities, and can be divided into primary and secondary forms. The latter have been associated with connective tissue diseases and lymphoma, as well as several plasma cell dyscrasias, such as macroglobulinemia and cryoglobulinemia.1 This is a report of a patient with γ—heavy-chain disease and recalcitrant atrophie blanche complicated by Serratia marcescens cellulitis.

Report of a Case.—  In 1974, a 51-year-old white man was seen who had developed painful purpuric papules and ulcerations on the extensor surfaces of the distal lower extremities. Eight years later he presented to another hospital with fever, abdominal cramps, diarrhea, and worsening of his skin ulcerations. Laboratory abnormalities included a mild anemia (hemoglobin, 1.75 mmol/L), leukopenia (leukocyte count, 3.0 × 109/L), and an occasional plasmacytoid cell in the peripheral smear. Serum protein electrophoresis showed a monoclonal

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