多发性骨髓瘤患者的高γ-球蛋白血症性紫癜

Hyperglobulinemia purpura in multiple myeloma:a case report

报告1例多发性骨髓瘤患者合并高γ-球蛋白血症性紫癜。患者男,73岁。因双下肢瘀点、瘀斑20 d,疼痛4 d入院。体格检查:消瘦、贫血貌、慢性重病容。皮肤科检查:双下肢,以双足踝、足底为主可见对称、密集分布的暗红色斑疹,部分融合成红褐色瘀斑。腹部CT示脂肪肝,胆汁淤积。实验室检查示外周血γ球蛋白升高;骨髓涂片可见骨髓增生活跃,分类见骨髓瘤细胞。结合临床诊断为多发性骨髓瘤,高γ-球蛋白血症性紫癜。

A case of hyperglobulinemia purpura in multiple myeloma is reported.A 73-year-old male presented with petechiae and ecchymosis of both lower extremities for about 3 weeks and pain for 4 days.Physical examination revealed that the patient appeared to be emaciated,anemic and showed sights of chronic severe disease.Dermatological examination revealed symmetrical and densely distributed dark-red patches and macules on both lower limbs,mainly on both ankles and plantar.Some of those patches and macules were fused into red-brown ecchymosis.An abdominal CT scan showed fatty liver disease with cholestasis.Laboratory tests showed elevated gamma globulins in peripheral blood,active myeloid hyperplasia on bone marrow smear,and myeloma cells in bone marrow differential test.A diagnosis of hyperglobulinemia purpura in multiple myeloma is made with clinical correlation.