Hypergammaglobulinemic purpura of Waldenström

Hypergammaglobulinemic purpura of Waldenström is a rare syndrome that includes recurrent episodic purpura occurring mainly on the lower extremities and dorsum of the feet. The hallmark of this condition is polyclonal hypergammaglobulinemia primarily composed of IgG. Although the condition generally is benign, it may herald an underlying connective tissue disease or hematologic malignancy. We report a case of a 47-year-old woman with episodic purpura of 3 years' duration associated with Raynaud phenomenon.

Hypergammaglobulinemic purpura in two sisters with Sjogren?s syndrome responding to colchicine treatment

Purpura is the hallmark of hypergammaglobulinemic purpura (HP). It appears mainly after strenuous activity in the dependent areas of the body. Treatment is mostly symptomatic. Here we report two sisters with Sjogren's syndrome (SS) and HP who had a remarkable response to colchicine treatment.

Hypergammaglobulinemic purpura of Waldenström: report of 3 cases with a short review

Benign hypergammaglobulinemic purpura of Waldenström (HGPW) is an uncommon cause of non-thrombocytopaenic purpura that may create diagnostic difficulties. The presence of constitutional symptoms associated with prominent immunological abnormalities may raise alarm, leading to extensive and often unnecessary investigations. This report describes 3 young women with HGPW. Clinical features were characterised by recurrent episodes of bilateral asymmetrical palpable purpuric lesions on the lower extremities that were precipitated by a prolonged increase in hydrostatic pressure (e.g. prolonged standing, tight stockings etc.) associated with constitutional features. In one patient the condition was secondary to Sjögren's syndrome with type IV renal tubular acidosis. Laboratory abnormalities included a persistently elevated erythrocyte sedimentation rate, marked polyclonal hypergammaglobulinemia, and high titers of rheumatoid factor and anti-nuclear antibody of the anti-SSA (anti-Ro)/anti-SSB(anti-La) subsets. This topic is reviewed briefly with the emphasis that in its 'primary' form this condition could be considered a 'benign' systemic immunoinflammatory disease that requires neither extensive investigations nor any aggressive form of therapy. Greater awareness of HGPW may increase the frequency of its diagnosis, especially in the patient group with non-thrombocytopenic purpura or the so-called cutaneous vasculitic syndromes with 'palpable purpura'.

Hypergammaglobulinemic purpura associated with Sjögren's syndrome and chronic C type hepatitis

Although hypergammaglobulinemic purpura usually occurs secondarily on the lower legs in several disorders, purpura has also recently been reported to be associated with chronic C type hepatitis (HCV). To define the differences in the clinical, histological and laboratory findings and the prognosis of hypergammaglobulinemic purpura associated with those two disorders, we examined ten patients with hypergammaglobulinemic purpura, 6 patients with hypergammaglobulinemic purpura associated with Sjögren's syndrome (SjS) and 4 patients with hypergammaglobulinemic purpura with chronic C type hepatitis. Five of 6 patients with SjS were female. Attacks of purpura occurred in the pretibial area in all cases. Triggering factors included long walks and prolonged standing. The mean duration of attacks was 6.4 days. No systemic manifestations were associated. Anti-Ro/SS-A and anti-La/SS-B antibodies were expressed in one case. Spontaneous regression was noted in all cases; however, recurrence was noted in one. On the other hand, all the 4 patients with hypergammaglobulinemic purpura associated with HCV were men. Purpura was indurated in a few cases. Involved sites included the knee, forearm, abdomen and thigh in addition to the lower leg. The mean duration of attacks was 12.6 days. Recurrent purpura was noted in one case. Cryoglobulin was positive in three cases. In one patient with severe recurrent purpura, attacks stopped with prednisolone 10 mg/day. Histologically, leukocytoclastic vasculitis was detected in three cases associated with SjS and two cases with HCV. In conclusion, hypergammaglobulinemic purpura associated with HCV appears to occur unilaterally with a sex predilection for men and the manifestations last longer than those associated with SjS. Severe palpable purpura was also noted in association with HCV; systemic prednisolone resulted in good control.

Hypergammaglobulinemic purpura of Waldenström

Hypergammaglobulinemic purpura of Waldenström is characterized by hypergammaglobulinemia, recurring purpura, an elevated erythrocyte sedimentation rate, and the presence of rheumatoid factor indicative of circulating immune complexes. There is a significant association with autoimmune diseases, especially Sjögren's syndrome and lupus erythematosus. Hypergammaglobulinemic purpura is considered primary when there is no other associated disease or secondary when associated with other diseases, usually autoimmune. Immune derangements are fundamental in its pathogenesis, although its cause is still unknown. Therapy is unrewarding and is probably unnecessary for this usually benign condition. Three cases are presented that are representative of patients with hypergammaglobulinemic purpura.

Cutaneous manifestations of cystic fibrosis: possible role of cryoglobulins

A 13-year-old girl with cystic fibrosis (CF), severe lung disease, purpura on the lower extremities and with elevated serum mixed cryoglobulins is described. The possible relationship of the purpura in CF with cryoglobulinaemia is discussed.

Purpuric rashes in cystic fibrosis

Sixteen patients with cystic fibrosis experienced vasculitic rashes of the lower extremities that resembled hypergammaglobulinemic purpura. The rashes were associated with increased serum gammaglobulin G levels and rather severe lung disease. The rashes are probably the expression of chronic lung infection and high antigenic load in these patients. Their appearance was associated, in most cases, with poor long-term survival.

Hyperglobulinemic purpura in the course of multiple myeloma

Secondary hyperglobulinemic purpura of Waldenström is characterized by polyclonal gammopathy associated mainly with autoimmune diseases. Its occurrence with multiple myeloma is very rare. We described a patient who developed characteristic lesions of hyperglobulinemic purpura in the course of IgA myeloma. Skin biopsy revealed deposition of IgA in the blood vessels.

[Hematological manifestations and complications in Sjögren's syndrome (author's transl)]

The main hematological manifestations and complications seen in 18 cases of Sjögren's syndrome are described: a slight anemia of the inflammatory type, a leucopenia, and/or an eosinophilia occur in about half of the patients. One case of auto-immune hemolytic anemia, one of pernicious anemia, 3 of hypoplastic anemia--one of them drug-induced--, and one of thrombocytopenic purpura have also occurred. The clinical and biological manifestations related to the disturbed immunologic status are also frequent: hyperglobulinemic purpura. Raynaud's syndrome due to cryoglobulinemia, rheumatoid factor, anti-nuclear factor. In 4 patients, the disease presented with or evolved into lymphadenopathy and/or splenomegaly; the initial "pseudo-lymphoma" diagnosis corresponded to different aspects or courses: in one cases, malignancy appeared soon, another has evolved in a chronic lympho-proliferative disease, a third one had the histologic features of angio-immunoblastic lymphadenopathy. These various manifestations, which may reveal the Sjögren's syndrome, are discussed in the light of the litterature data.