To the Editor.—
The hyperviscosity syndrome has been associated with various dermatologic manifestations. Among these are Raynaud's phenomenon, livedo reticularis, digital infarcts, peripheral gangrene, and palpable purpura.1 We describe a patient with immunoblastic lymphoma and hyperviscosity syndrome due to overproduction of IgG-k who presented with spider nevus—like lesions.
Report of a Case.—
The patient, a 34-year-old male coal miner, presented in May 1988 complaining of visual disturbances, fatigue, and night sweats of 6 months' duration. His skin eruption started 4 months before admission as nontender, nonpruritic erythematous papules mainly on the face and dorsa of the hands. He drank three or four bottles of wine per week and "moonshine" once a month.On examination, both fundi showed blurred optic disc margins with numerous hemorrhages and exudates and tortuous, dilated vessels with a boxcarlike appearance. A large, nontender, firm nodule was noted in the left upper parasternal area. The liver edge was palpable, soft, and nontender, with an increased span of 16 cm. He had