CHRONIC URTICARIA, ARTHRALGIA, RAISED ERYTHROCYTE SEDIMENTATION-RATE AND IGG PARAPROTEINEMIA - A VARIANT OF SCHNITZLERS SYNDROME

Schnitzler's syndrome is a distinct disease entity characterized by th e association of chronic urticaria, intermittent fever, arthralgia, el evated erythrocyte sedimentation rate and IgM macroglobulinaemia. We r eport a patient with the same symptoms, but a monoclonal IgG instead o f IgM gammopathy, Histological examination of the urticarial lesions s howed signs of mild leucocytoclastic vasculitis. Except for the differ ent class of the monoclonal immunoglobulin, the clinical symptoms, lab oratory findings and histology in this patient were identical with tho se in classical Schnitzler's syndrome. IgG and IgM paraproteins may be equivalent with regard to the putative pathophysiology of the disease process in Schnitzler's syndrome. We therefore suggest that the spect rum of Schnitzler's syndrome is expanded to include patients with chro nic urticaria and monoclonal IgG gammopathy, as a closely related vari ant.