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IgA multiple myeloma presenting as an acquired bullous disorder
Author(s) -
Wong Deanna A,
Hunt Michelle J,
Stapleton Karen
Publication year - 1999
Publication title -
australasian journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.67
H-Index - 53
eISSN - 1440-0960
pISSN - 0004-8380
DOI - 10.1046/j.1440-0960.1999.00312.x
Subject(s) - medicine , dermatitis herpetiformis , epidermolysis bullosa acquisita , pathology , dermatology , multiple myeloma , biopsy , skin biopsy , rash , immunoglobulin a , immunopathology , autoantibody , antibody , immunoglobulin g , disease , immunology
A 63‐year‐old man presented with an intensely pruritic vesiculo‐bullous eruption on the limbs and was subsequently found to have an IgAκ multiple myeloma. The eruption clinically and histologically was suggestive of linear IgA disease (LAD), dermatitis herpetiformis (DH), epidermolysis bullosa acquisita (EBA), or bullous lupus erythematosus (LE), with the skin biopsy revealing subepidermal bullae and dermal papillary microabscesses. However, direct immunofluorescence showed a unique pattern of diffuse dermal IgA staining. Although chemotherapy produced a dramatic resolution of the lesions, which paralleled the fall in serum IgA paraprotein level, the myeloma later became progressive and the resulting paraprotein increase was accompanied by recurrence of the eruption. We propose that this patient’s rash was the presenting manifestation of his multiple myeloma, and was a consequence of transudation of IgA paraprotein into the dermis.