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Case Reports in Rheumatology
Volume 2011 (2011), Article ID 124940, 3 pages
http://dx.doi.org/10.1155/2011/124940
Case Report

Leukocytoclastic Vasculitis in a Patient with Type 1 Cryoglobulinemia

1Division of Rheumatology, Department of Medicine, University of California, Irvine, Orange, CA 92868, USA
2Veterans Administration Healthcare System, Long Beach, CA 90822, USA

Received 9 July 2011; Accepted 3 August 2011

Academic Editors: J. V. Dunne, M. Salazar-Paramo, and A. Zoli

Copyright © 2011 Paul Y. Liu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cutaneous manifestations of type 1 cryoglobulinemia are usually related to vascular occlusion by noninflammatory thrombosis; rarely is leukocytoclastic vasculitis seen in type 1 cryoglobulinemia. We report the case of a 64-year-old male who presented with isolated cutaneous leukocytoclastic vasculitis that was initially attributed to essential mixed cryoglobulinemia after thorough diagnostic evaluation. A lack of adequate clinical response to therapy prompted further investigation, including cryoprecipitate electrophoresis and immunofixation, which revealed an IgM kappa monoclonal gammopathy consistent with type 1 cryoglobulinemia. A renewed search for an underlying malignancy led to the discovery of early Waldenstrom's macroglobulinemia. Although leukocytoclastic vasculitis is more characteristic of mixed cryoglobulinemia, it can be a presenting manifestation of type 1 cryoglobulinemia.