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September 1994

Urticarial Lesions and Monoclonal IgM Gammopathy

Author Affiliations

Hospital General, Valencia, Spain

Arch Dermatol. 1994;130(9):1198. doi:10.1001/archderm.1994.01690090131023

REPORT OF A CASE  A 69-year-old woman presented with recurrent urticarial dermatosis of 20 years' duration. The cutaneous lesions appeared in crops, particularly during winter, with a frequency of 7 to 14 days. Occasionally, the urticarial attacks were associated with fever and arthralgias. Multiple treatments with different antihistamines and oral corticosteroids did not control the rash.The cutaneous lesions appeared as multiple asymptomatic erythematous urticarial papules, 1 to 2 cm in diameter, mainly located on the lower limbs and abdomen. Each lesion lasted from a few hours to a few days and healed with a palpable purpuric residual macule (Figure 1).The rest of the physical examination showed only moderate hepatomegaly and splenomegaly. No lymph node enlargement was observed.Hemogram, electrolytes, serum creatinine, liver function tests, and urinalysis showed normal findings. The erythrocyte sedimentation rate was 72 mm/h. Immunoelectrophoresis identified a serum monoclonal IgM-K (light-chain isotype) (<5g/L). Protein electrophoresis of

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