multiple myeloma with gangrene of all four extremities

introduction: multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone and it results in bone pain or fracture, renal failure, susceptibility to infections, anemia, and hypercalcemia. the hyperviscosity syndrome is rare. cryoglobulins are immunoglubulins that precipitate in the cold temperature less than 37˚c. monoclonal cryoglobulins are associated with a significant hematologic disorder and are often asymptomatic. we reported the second case of multiple myeloma with gangrene of all four extremities. case: the patient was a 77 year-old farmer who was referred due to 2-weeks history of blue, cold and painful fingers spread to middle of forearms and forelegs which was accompanied by feet skin erosions, dark points on auricle and discoloration of nose tip. in physical examination, quadrigangrene associated with auricle and tip of nose ischemia was seen. serum proteins electrophoresis demonstrated monoclonal gammopathy and serum was positive for cryoglobulin. bone marrow study showed neoplastic plasma cells infiltration. the patient with cryoglobulinemia, based on multiple myeloma was treated.