Dermatology Case Challenge: Colorful Skin Patches on a Man With Fatigue Who Smokes Cigars

Malgorzata K. Nowakowska, BS; Saira George, MD

Disclosures

November 22, 2022

Physical Examination and Workup

Upon physical examination, the patient appears relaxed and comfortable. His vital signs include a temperature of 98.1 °F (36.7 °C), a blood pressure of 145/65 mm Hg, a heart rate of 62 beats/min, and a respiration rate of 18 breaths/min.

Examination of the skin reveals diffuse, symmetric yellow-orange thin plaques involving the upper torso and upper arms (Figure 1 and Figure 2). He has no mucosal involvement. Sclera, conjunctiva, and eyelids are clear, without signs of jaundice.

Figure 1.

Figure 2.

The bloodwork results are notable for normal total, low-density lipoprotein, and high-density lipoprotein cholesterol levels and triglyceride levels. A complete blood cell count is unremarkable, except for mild anemia (hemoglobin level, 12.7 g/dL; reference range, 13.8-17.2 g/dL) and mild thrombocytopenia (127,000 cells/μL; reference range, 150,000-450,000 cells/μL). Serum electrophoresis and immunofixation are ordered and show an M protein level of 3.0 g/dL (reference range, 0.57-2.63 g/dL) and an immunoglobulin G (IgG) kappa monoclonal gammopathy.

The patient is referred to the hematology-oncology service. After an extensive workup of his monoclonal gammopathy, including a bone marrow biopsy and a bone survey, he is found to have smoldering multiple myeloma.

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