Case Report

Cold Agglutinin Disease in Non-Secretory Multiple Myeloma: A Case Report

Abstract

Skin involvement is not common as the first manifestation of Multiple Myeloma (MM). Although extremely rare, leucocytoclastic vasculitis, plasmasytoma, autoimmune bullous disease, livedo reticularis and Raynaud’s phenomenon may be the initial presentationof MM. Raynaud’s phenomenon and livedo reticularis related to cold exposure can be due to Cold Agglutinin Disease (CAD) or cryoglobulinemia and can be seen as the first manifestation of MM. In this case study, we described a 55-year-old man complaining of limbs livedo reticularis and Raynaud’s phenomenon during cold weather. Further evaluations revealed anemia and elevated ESR. Skull X-ray showed multiple punched-out lesions. Finally, serum protein electrophoresis and bone marrow aspiration confirmed the diagnosis of non-secretory MM as the underlying disease of CAD. The patient was referred to the hematologist for the treatment of MM.

[1] Kariyawasan CC, Hughes DA, Jayatillake MM, Mehta AB. Multiple myeloma: Causes and consequences of delay in diagnosis. QJM: An International Journal of Medicine. 2007; 100(10):635-40. [DOI:10.1093/qjmed/hcm077] [PMID]
[2] Khatun H, Afrose S, Khan MH, ARA T, Islam S. Cold agglutinin disease secondary to multiple myeloma in a psoriatic patient. Journal of Medicine. 2014; 15(2):141-3.
[3] Ravindran A, Kyle R, Sankaran J, Jacob E, Kreuter J, Christopher Hook C, et al. High prevalence of monoclonal gammopathy among patients with warm autoimmune hemolytic anemia. American Journal of Clinical Pathology. 2016; 46(Suppl-1):180. [DOI:10.1093/ ajcp/aqw151.041]
[4] Swiecicki PL, Hegerova LT, Gertz MA. Cold agglutinin disease. Blood. 2013; 122(7):1114-21. [DOI:10.1182/blood 2013 02-474437] [PMID]
[5] Monti G, Galli M, Invernizzi F, Pioltelli P, Saccardo F, Monteverde A, et al. Cryoglobulinaemias: A multi-centre study of the early clinical and laboratory manifestations of primary and secondary disease; GISC. Italian Group for the Study of Cryoglobulinaemias. QJM: An International Journal of Medicine. 1995; 88(2):115-26. [PMID]
[6] Payet J, Livartowski J, Kavian N, Chandesris O, Dupin N, Wallet N, et al. Type I cryoglobulinemia in multiple myeloma, a rare entity: Analysis of clinical and biological characteristics of seven cases and review of the literature. Leukemia & Lymphoma. 2013; 54(4):767- 77. [DOI:10.3109/10428194.2012.671481] [PMID]
[7] Ng YC, Schifferli JA. Clearance of cryoglobulins in man. Springer Seminars in Immunopathology. 1988; 10(1):75-89. [DOI:10.1007/ BF02054025]
[8] Terrier B, Karras A, Kahn JE, Le Guenno G, Marie I, Benarous L, et al. The spectrum of type I cryoglobulinemia vasculitis: New insights based on 64 cases. Medicine. 2013; 92(2):61-8. [DOI:10.1097/ MD.0b013e318288925c] [PMID] [PMCID]
[9] Ramos-Casals M, Stone JH, Cid MC, Bosch X. The cryoglobulinaemias. The Lancet. 2012; 379(9813):348-60. [DOI:10.1016/S0140- 6736(11)60242-0]
[10] Barcellini W, Fattizo B, Zaninoni A, Radice T, Nichele I, Di Bona E, et al. Clinical heterogeneity and predictors of outcome in primary autoimmune hemolytic anemia: A GIMEMA study of 308 patients. Blood. 2014; 124(19):2930-6. [DOI:10.1182/ blood-2014-06-583021] [PMID]
[11] Berentsen S. How I manage cold agglutinin disease. British Journal of Haematology. 2011; 153(3):309-17. [DOI:10.1111/j.1365- 2141.2011.08643.x] [PMID]
[12] Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clinic Proceedings. 2003; 78(1):21-33. [DOI:10.4065/78.1.21] [PMID]
[13] Dupuis MM, Tuchman SA. Non-secretory multiple myeloma: From biology to clinical management. OncoTargets and Therapy. 2016; 9:7583-90. [DOI:10.2147/OTT.S122241] [PMID] [PMCID]
Files
IssueVol 4 No 4 (2019): Autumn QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v4i4.2387
Keywords
Cold agglutinin Multiple myeloma Raynaud’s phenomenon Anemia

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How to Cite
1.
Abbaszadeh M, Radkhah H, Karimpour Reyhan S, Khajavirad N. Cold Agglutinin Disease in Non-Secretory Multiple Myeloma: A Case Report. CRCP. 2020;4(4):110-114.