PMC6358358_01
(A) Cyanosis of hands after cold exposure. (B) Purpuric skin lesions in May 2018. (C) Dramatically improved skin lesions after 2 cycles of bortezomib-based therapy.
medi-98-e14201-g001.jpg
PMC6358358_01_medi-98-e14201-g001.jpg
F1
A 72-year-old Chinese woman presented with a 25-year history of cyanosis of the extremities after cold exposure (Fig. 1A), which worsened and was accompanied with purpuric skin lesions (Fig. 1B) and proteinuria in recent years. In addition, the cutaneous rash dramatically improved (Fig. 1C) and 24-hour urine total protein decreased to 0.03 g, suggesting the remission of cryoglobulinemic vasculitis.
Bone marrow biopsy showed red blood cells gathering and piling up together, with no evidence of malignancies.
medi-98-e14201-g003.jpg
PMC6358358_01_medi-98-e14201-g003.jpg
F2
Red blood cells could still be seen gathering and piling up together in the bone marrow biopsy (Fig. 2).
Skin biopsy showing hyaline thrombus in the lumen of blood vessels (A, x100; B, x400).
medi-98-e14201-g004.jpg
PMC6358358_01_medi-98-e14201-g004.jpg
F3
Skin biopsy was also performed on the lesion of her right leg (Fig. 3).