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May 1996

Treatment of Recalcitrant Leg Ulcers in Cryoglobulinemia Types I and II With Plasmapheresis

Author Affiliations

USA; USA; USA; Fitzsimons Army Medical Center, Aurora, Colo

Arch Dermatol. 1996;132(5):498-500. doi:10.1001/archderm.1996.03890290024003


CASE 1  In November 1989, a 60-year-old white man with a 2-year history of chronic lymphocytic leukemia presented with a 1-week history of pain in both feet accompanied by progressive purpura and petechiae in the lower extremities. Purpura over both lateral malleoli and the right medial tibia ulcerated during the next 2 weeks (Figure 1, top). A skin biopsy specimen of a purpuric lesion revealed vascular occlusion with amorphous, eosinophilic material that was periodic acid Schiff—positive, diastase resistant, and phosphotungistic acid—hematoxylin negative. A mild perivascular infiltrate of lymphocytes and eosinophils was present. Special stains for organisms were negative.The patient's cryoglobulin screen demonstrated a cryocrit of 0.3, 0.2, and 0.5 at temperatures of 4°C, 22°C, and 37°C, respectively. Cryoglobulin analysis revealed a monoclonal IgG-K type I cryoglobulinemia (CG). Despite two courses of chlorambucil (30 mg/d for 5 days every 4 weeks) and prednisone (20 to 60 mg/d),

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