Therapy resistant leg ulcer caused by multiple myeloma

• Published in: Orvosi hetilap Vol. 144; no. 37; p. 1829
• Main Authors: Bagó, Andrea, Schweitzer, Katalin, Kis, Miklós, Fúrész, József, Vajda, Adrienne, Baló-Banga, J Mátyás
• Format: Journal Article
• Language: Hungarian
• Published: Hungary 14.09.2003
• Subjects: Aged; Biopsy, Needle; Bone Marrow - pathology; Diagnosis, Differential; Erythropoietin - administration & dosage; Female; Humans; Leg Ulcer - etiology; Leg Ulcer - pathology; Leg Ulcer - therapy; Multiple Myeloma - complications; Multiple Myeloma - diagnosis; Multiple Myeloma - pathology; Multiple Myeloma - therapy; Plasmapheresis; Sternum
• ISSN: 0030-6002

The authors review an elderly woman suffering from leg ulcer with bad curability which was a consequence of a malignant haematologic disease. Multiple relapse of this ulcer was observed and did not react to usual conservative therapy. The only sign of multiple myeloma was the extremely high level of iron measured in the blood serum bound to a monoclonal paraprotein. Sternum aspiration was made and the sample showed presence of plasmoblasts supporting diagnosis of multiple myeloma. The poor therapeutical results were caused by hyperviscosity syndrome in consequence of the high level of the monoclonal component in the blood serum. The ulcer was cured within eight weeks by suppression of the monocloclonal component and thus, elimination of hyperviscosity. This case is a special one from several points of view. Leg ulcers not reacting to usual therapy may be caused by haematologic disease thus the physician should consider this and extend examinations as well and necessarily hospitalize patient. Appearance of multiple myeloma is unusual in this case. Hystology made from the skin excised from the periphery of the wound has not showed signs of pyoderma gangrenosum, which is known mostly being associated with multiple myeloma.