Violaceous discoloration around the eyes.

WHAT IS YOUR DIAGNOSIS? A 57–year-old male presented with dark pigmentation around the eyelids, of one-year duration. He also had joint pain and weight loss for the same duration. A general physical examination revealed pedal edema and pallor, while a systemic examination showed ascites, pleural effusion (right), and asterixis. A dermatological examination revealed violaceous pigmentation on both eyelids [Figure 1]. The patient also had similar lesions on the neck, axilla, and upper chest. Macroglossia was present as was alopecia. Investigations revealed turbidity in the urine with proteinuria of 3+ and high 24-hour urinary protein levels. Blood urea and serum creatinine were raised. An X-ray of the skull showed multiple translucencies and that of the hips and spine showed osteosclerosis. Serum electrophoresis revealed M protein with gamma