case_images: PMC11833384_01
case_images: Mucocutaneous findings. (A) Retiform purpura and hemorrhagic bullae on the legs. (B) Retiform purpura in the lumbar region. (C) Retiform purpura on the thighs. (D) Nasal crusts with active epistaxis.
case_images: cureus-0017-00000077647-i01.jpg
case_images: PMC11833384_01_cureus-0017-00000077647-i01.jpg
case_images: FIG1
case_images: Physical examination revealed hematic crusts in the nostrils without septal perforation and retiform purpura (Figure 1).
case_images: Clinical, immunological, and bone marrow findings. (A) Chest tomography revealing ground-glass opacities (yellow triangles). (B) Lytic lesions in the skull (white arrows). (C) Serum protein electrophoresis showing a monoclonal gamma peak. (D) Serum immunofixation positive for IgG-lambda. (E) Bone marrow biopsy displaying Rouleaux formation (asterisk) and 30% atypical plasma cells (arrows). (F) Skin biopsy (40x magnification) demonstrating a perivascular mixed inflammatory infiltrate of lymphocytes, plasma cells, and neutrophils (arrows), nuclear dust (triangle), and foci of fibrinoid necrosis in the vessel wall, consistent with LV.. LV, leukocytoclastic vasculitis
case_images: cureus-0017-00000077647-i02.jpg
case_images: PMC11833384_01_cureus-0017-00000077647-i02.jpg
case_images: FIG2
case_images: C4 hypocomplementemia (Table 1). Chest CT showed peripheral ground-glass opacities (Figure 2A), and the skin biopsy confirmed LV (Figure 2F). Bone marrow biopsy confirmed the diagnosis of MM (Figure 2).