Abstract
A 67-year-old man recently diagnosed as having Waldenstrom macroglobulinemia (WM) presented with an asymptomatic cutaneous eruption on his shins, ankles, and feet for several days. The diagnosis of WM was based on findings from immunoelectrophoresis, which demonstrated a monoclonal IgM spike, and a bone marrow aspirate that revealed lymphoplasmacytic lymphoma with extensive plasmacytic differentiation. The volume percentage of quantitative cryoglobulins was 1% (reference range, 0%-0.5%). He reported a history of peripheral neuropathy. Findings from physical examination showed several shiny, erythematous, dome-shaped papules on the anterior aspect of the shins, ankles, and dorsa of the feet (Figure 1). Many lesions were scaly and hemorrhagic. A biopsy specimen was obtained from the left shin (Figure2) and was evaluated by electron microscopy (Figure 3). What is your diagnosis?
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