In a recent issue of the Archives, McGovern et al1 reported the efficacy of plasmapheresis in 2 patients with recalcitrant leg ulcers secondary to cryoglobulinemia (types I and II, one case each). The authors proposed using plasmapheresis as a second-line therapy, and even as a first-line therapy, in patients with rapidly progressive disease with painful purpura or ulcerations. They did not discuss the possibility that failure of plasmapheresis might occur, which we would like to address.
Report of a Case.
A 60-year-old woman presented with a 2-year history of purpura. A mixed cryoglobulinemia (IgM-κ and IgG) was discovered. A cutaneous biopsy specimen showed leukocytoclasis and fibrinoid necrosis of the dermal vessels. Painful necrotic ulcerations, peripheral neuropathy, and mild renal involvement (maximum proteinuria level, 0.6 g/d with normal creatinine levels) occurred a few months later. Blood cell count and liver function test results were normal. Antinuclear antibody and serologic test
Machet L, Vaillant L, Gironnet N, Bouchindhomme B, Perrotin D, Lorette G. Failure of Plasmapheresis in the Treatment of Recalcitrant Skin Ulcers in a Patient With Mixed Cryoglobulinemia. Arch Dermatol. 1997;133(3):389-390. doi:10.1001/archderm.1997.03890390133025