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Figure 1. A 57-year-old woman was admitted because of ischemia of the feet (Panel A). A monoclonal IgG-  gammopathy and type I cryoglobulinemia (cryocrit, 13.8 percent) were found in the serum, and a bone marrow biopsy revealed multiple myeloma with plasmablastic features (inset; Giemsa, x1000). Gangrene developed, with subsequent mummification of the left foot (Panel B), despite treatment with intensive plasmapheresis, epoprostenol, and vincristine, doxorubicin, and dexamethasone. A conservative amputation was carried out after the completion of six cycles of chemotherapy. After the chemotherapy, the cryoglobulins disappeared from serum (cryocrit, 0), but the myeloma persisted in the bone . . . [Full Text of this Article] |
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