Cold Agglutinin Disease in Non-Secretory Multiple Myeloma: A Case Report

Skin involvement is not common as the first manifestation of Multiple Myeloma (MM).
Although extremely rare, leucocytoclastic vasculitis, plasmasytoma, autoimmune bullous
disease, livedo reticularis and Raynaud’s phenomenon may be the initial presentation
of MM. Raynaud’s phenomenon and livedo reticularis related to cold exposure can be due to Cold Agglutinin Disease (CAD) or cryoglobulinemia and can be seen as the first manifestation of MM. In this case study, we described a 55-year-old man complaining of limbs livedo reticularis and Raynaud’s phenomenon during cold weather. Further evaluations revealed anemia and elevated ESR. Skull X-ray showed multiple punched-out lesions. Finally, serum protein electrophoresis and bone marrow aspiration confirmed the diagnosis of non-secretory MM as the underlying disease of CAD. The patient was referred to the hematologist for the treatment of MM.