WALDENSTROM MACROGLOBULINEMIA-INDUCED BULLOUS DERMATOSIS

Background: Waldenstrom macroglobulinemia is a plasma cell dyscrasia o f undetermined cause characterized by the monoclonal proliferation of lymphoplasmacytes in the bone marrow, lymph nodes, and spleen and elev ated circulating levels and tissue deposition of monoclonal IgM produc ed by these aberrant cells. Rarely, cutaneous manifestations of this d isease have been reported. Observations: We report the case of a patie nt with bullous dermatosis induced by Waldenstrom macroglobulinemia an d demonstrate the subepidermal location of the separation and the pres ence of IgM and kappa light chains by immunoperoxidase, immunofluoresc ent techniques, and electron microscopy with immunogold staining. Immu noblotting revealed a strong band at the 290-kd area. Conclusions: The demonstration of the separation in the upper dermis at the site of Ig M deposits suggests that these deposits may be an etiologic factor in this rare manifestation.