Monoclonal Gammopathy of Undetermined Significance and Neutrophilic Dermatosis.

Abstract

A 62-year-old female presented with a three-day history of painful purple-red nodules on her face and extremities [Figure 1] associated with generalized malaise and arthralgia. The patient had a significant medical history of monoclonal gammopathy of undetermined significance diagnosed in 2008, ovarian cancer, which was treated with surgery and chemotherapy in 2010, and thyroid cancer for which she underwent a thyroidectomy in 2011. Laboratory investigations showed normal complete blood counts, high C-reactive protein levels (27.4 mg/L; normal range 0–5 mg/L), normal renal and liver function, normal CA 125 level, and normal bone marrow biopsy. Serum protein electrophoresis showed monoclonal immunoglobulin (Ig)-A with lambda peak. A skin biopsy revealed diffuse neutrophilic dermatitis with no evidence of vasculitis or stainable microorganisms. Figure 1 Erythematous, tender nodules, and papules, some with central crusting distributed asymmetrically over the face, dorsum hands, arms, and thighs.