Severe Henoch-Schonlein purpura in multiple myeloma. Report of one case

A Multiple Myeloma (MM), IgG-lambda stage III-A was diagnosed in a 41-year- old-man. After VAD cycles IgG decreased from 7.5 to 2.4 g/dL were mobilized with cyclophosphamide and 10 mug/Kg G-CSF. Three days after the collection of peripheral stem cell, the patient had fever, nausea, vomiting, liquid s tools, shoulder and knee arthralgia and dehydration. Upper GI endoscopy sho wed eosophageal candidiasis and ulcerative necrotic lesions both in stomach and duodenum; the biopsy confirmed necrosis. Simultaneously, the appearanc e of purpura with maculopapular lesions of diverse sizes appeared in the fe et progressing to the limbs and trunk. Hematuria and proteinuria were also observed. Skin biopsy showed leukocytoclastic vasculitis. Renal biopsy show ed focal and segmental glomerulonephritis. Serum ANCA, cryoglobulins, anti- HCV and RF were negative, and serum monoclonal IgG was 1290 mg/dL. Daily tr eatment with iv methylprednisolone pulses for 3 days improved skin lesions and digestive involvement. Macroscopic hematuria and proteinuria improved a fter two months of steroid treatment (Rev Med Chile 2000; 128: 1255-60).