PMC9924627_01
Skin findings on bedside physical examination. Panel A demonstrates a violaceous, non-blanching, purpuric rash involving the bilateral knees and extensor surfaces of the lower extremities. Panel B demonstrates erosive oral ulcerations upon a background of petechiae and purpura. Panel C demonstrates evidence of a necrotic appearing lesion of the left pinnae.
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The oropharynx and bilateral calcanei demonstrated superimposed necrosis with shallow ulceration upon the background rash (Fig. 1).
Immunohistochemical staining of bone marrow biopsy. Panel A demonstrates a Hematoxylin and Eosin (H&E) stain highlighting the effacement of normal hematopoietic marrow elements by sheets of plasma cells, characterized by abundant pink cytoplasm, eccentric nuclei, perinuclear clearing and clock-face chromatin. Panel B demonstrates diffuse immunohistochemical staining for CD138, a surface plasma cell marker. Panel C demonstrates abundant kappa-positivity in the plasma cells, Panel D displays plasma cells which are negative for lambda by immunohistochemistry.
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Bone marrow biopsy confirmed the diagnosis of MM with plasma cells comprising at least 60% cellularity with kappa-light chain predominance (Fig. 2).
PET/CT demonstrating foci of increased metabolic activity corresponding to lytic lesions in left iliac crest (SUV) = 5.7.
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Whole-body PET/CT demonstrated multiple FDG-avid osseous lesions in the thoracic and lumbar spine, left pelvis, and left hip favoring metastasis (Fig. 3).