Crystalglobulinemia with fulminant course with cylinder-like bodies on peripheral blood smear

Intern Med. 2014;53(16):1847-51. doi: 10.2169/internalmedicine.53.1775. Epub 2014 Aug 15.

Abstract

A 63-year-old woman presented to our hospital with fever, purpura and pain in both legs and died 4 days after admission. Her blood smear and skin biopsy showed cylinder-like bodies (20×120 μm). She was diagnosed to have monoclonal gammopathy (IgG, lambda type). An autopsy revealed cylinder-like bodies in the vasculature of various organs. We noted a proliferation of atypical plasma cells in her bone marrow, suggesting pre-existing myeloma. Crystalglobulinemia is a rare manifestation of hypergammaglobulinemia that can cause multiple embolisms of the small vessels, and this resulted in the patient's fulminant course. The identification of cylinder-like bodies in the peripheral blood may help in reaching a diagnosis in such cases.

Publication types

  • Case Reports

MeSH terms

  • Biopsy
  • Bone Marrow / pathology
  • Crystallization
  • Fatal Outcome
  • Female
  • Hematologic Tests
  • Humans
  • Hypergammaglobulinemia / blood*
  • Hypergammaglobulinemia / pathology*
  • Immunoglobulin lambda-Chains / blood*
  • Multiple Myeloma / complications
  • Multiple Myeloma / pathology
  • Plasma Cells / pathology
  • Skin / blood supply
  • Skin / pathology

Substances

  • Immunoglobulin lambda-Chains