Type II Cryoglobulinemia
A 50-year-old Caucasian man with Raynaud's phenomenon and numbness and tingling in his toes complained of purpuric lesions. The lesions began on his bilateral lower extremities approximately six years previously when he was diagnosed with Hepatitis C. An ulcer developed on his dorso-lateral foot approximately five months prior to presentation, which began as a small erosion. He complained of intermittent joint pain of his shoulders.
His past medical history includes gastroesophageal reflux disease and precirrhotic liver changes. Medications include interferon, prednisone, cyclophosphamide, cisapride, oxycodone hydrochloride/acetaminophen, and levofloxacin.
Physical exam revealed multiple, reddish-brown, 1-3mm macules extending from the thighs down to the toes. There was pitting edema of the left lower extremity, particularly of the left foot (Figure 1). A large, deep ulcer with a necrotic base, measuring 4.5cm x 4.5cm, was present on the lateral aspect of the left foot. Tendons were visible. The ulcer was covered with thick yellow exudate as well as a hemorrhagic crust (Figure 2). There was an erythematous border around the ulcer and it was exquisitively painful, most likely from infection (Figure 3).
(Enlarge Image)
Figure 1.
Physical exam revealed multiple reddish-brown, 1-3mm macules extending from the thighs down to the toes. There was pitting edema of the left lower extremity, particularly of the left foot.
(Enlarge Image)
Figure 2.
A large, deep ulcer with a necrotic base, measuring 4.5cm x 4.5cm, was present on the lateral aspect of the left foot. Tendons were visible. The ulcer was covered with thick yellow exudate as well as a hemorrhagic crust.
(Enlarge Image)
Figure 3.
There was an erythematous border around the ulcer, and it was exquisitively painful, most likely from infection.
A 50-year-old Caucasian man with Raynaud's phenomenon and numbness and tingling in his toes complained of purpuric lesions. The lesions began on his bilateral lower extremities approximately six years previously when he was diagnosed with Hepatitis C. An ulcer developed on his dorso-lateral foot approximately five months prior to presentation, which began as a small erosion. He complained of intermittent joint pain of his shoulders.
His past medical history includes gastroesophageal reflux disease and precirrhotic liver changes. Medications include interferon, prednisone, cyclophosphamide, cisapride, oxycodone hydrochloride/acetaminophen, and levofloxacin.
Physical exam revealed multiple, reddish-brown, 1-3mm macules extending from the thighs down to the toes. There was pitting edema of the left lower extremity, particularly of the left foot (Figure 1). A large, deep ulcer with a necrotic base, measuring 4.5cm x 4.5cm, was present on the lateral aspect of the left foot. Tendons were visible. The ulcer was covered with thick yellow exudate as well as a hemorrhagic crust (Figure 2). There was an erythematous border around the ulcer and it was exquisitively painful, most likely from infection (Figure 3).
(Enlarge Image)
Figure 1.
Physical exam revealed multiple reddish-brown, 1-3mm macules extending from the thighs down to the toes. There was pitting edema of the left lower extremity, particularly of the left foot.
(Enlarge Image)
Figure 2.
A large, deep ulcer with a necrotic base, measuring 4.5cm x 4.5cm, was present on the lateral aspect of the left foot. Tendons were visible. The ulcer was covered with thick yellow exudate as well as a hemorrhagic crust.
(Enlarge Image)
Figure 3.
There was an erythematous border around the ulcer, and it was exquisitively painful, most likely from infection.
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