Monoclonal gammopathy in the setting of Pyoderma gangrenosum.
Cancer
Gammopathy
Leg ulcer
Monoclonal
Pyoderma gangrenosum
Journal
Archives of dermatological research
ISSN: 1432-069X
Titre abrégé: Arch Dermatol Res
Pays: Germany
ID NLM: 8000462
Informations de publication
Date de publication:
25 May 2024
25 May 2024
Historique:
received:
28
03
2024
accepted:
26
04
2024
revised:
28
03
2024
medline:
25
5
2024
pubmed:
25
5
2024
entrez:
25
5
2024
Statut:
epublish
Résumé
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by ulcerative painful lesions with violaceous undermined borders. Up to 75% of PG cases develop in association with an underlying systemic disease. Monoclonal gammopathy is reportedly a concomitant condition with PG, with studies indicating immunoglobulin (Ig) A gammopathy as the most common. Whether gammopathy is associated with PG or is an incidental finding has been debated. We sought to investigate the association and characteristics of gammopathy in patients with PG. We retrospectively identified PG patients at our institution from 2010 to 2022 who were screened for plasma cell dyscrasia. Of 106 patients identified, 29 (27%) had a gammopathy; subtypes included IgA (41%), IgG (28%), and biclonal (IgA and IgG) (14%). Mean age was similar between those with and without gammopathy (60.7 vs. 55.9 years; P = .26). In addition, hematologic or solid organ cancer developed in significantly more patients with vs. without gammopathy (8/29 [28%] vs. 5/77 [6%]; P = .003). Among the subtypes of gammopathy, IgG monoclonal gammopathy had the highest proportion of patients with subsequent cancer development (4 of 8 patients, 50%). Study limitations include a retrospective, single-institution design with a limited number of patients. Overall, our data show a high prevalence of gammopathy in patients with PG; those patients additionally had an increased incidence of cancer, especially hematologic cancer.
Identifiants
pubmed: 38795175
doi: 10.1007/s00403-024-03098-7
pii: 10.1007/s00403-024-03098-7
doi:
Substances chimiques
Immunoglobulin A
0
Immunoglobulin G
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
268Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Brunsting LA, Goeckerman WH, O’Leary PA (1930) Pyoderma (echthyma) gangrenosum: clinical and experimental observations in five cases occurring in adults. Arch Dermatol Syphilol 22(4):655–680
doi: 10.1001/archderm.1930.01440160053009
Birnkrant MJ, Papadopoulos AJ, Schwartz RA, Lambert WC (2003) Pyoderma Gangrenosum, acne conglobata, and IgA gammopathy. Int J Dermatol 42(3):213–216
doi: 10.1046/j.1365-4362.2003.01682.x
pubmed: 12653919
Montagnon CM, Fracica EA, Patel AA, Camilleri MJ, Murad MH, Dingli D et al (2020) Pyoderma Gangrenosum in hematologic malignancies: a systematic review. J Am Acad Dermatol 82(6):1346–1359
doi: 10.1016/j.jaad.2019.09.032
pubmed: 31560977
Hou YL, Lee CH (2022) Pyoderma Gangrenosum. JAMA Dermatol 158(2):202
doi: 10.1001/jamadermatol.2021.5001
pubmed: 34910081
Alavi A, French LE, Davis MD, Brassard A, Kirsner RS (2017) Pyoderma Gangrenosum: an update on pathophysiology, diagnosis and treatment. Am J Clin Dermatol 18(3):355–372
doi: 10.1007/s40257-017-0251-7
pubmed: 28224502
Alavi A, Sajic D, Cerci FB, Ghazarian D, Rosenbach M, Jorizzo J (2014) Neutrophilic dermatoses: an update. Am J Clin Dermatol 15(5):413–423
doi: 10.1007/s40257-014-0092-6
pubmed: 25154386
Katzmann J, Kyle RA, Lust J, Snyder M, Dispenzieri A (2013) Immunoglobulins and Laboratory Recognition of Monoclonal Proteins. In: Wiernik PH, Goldman JM, Dutcher JP, Kyle RA (eds) Neoplastic diseases of the blood. Springer New York, New York, NY, pp 565–588
doi: 10.1007/978-1-4614-3764-2_29
Mateos MV, Gonzalez-Calle V (2017) Smoldering multiple myeloma: who and when to treat. Clin Lymphoma Myeloma Leuk 17(11):716–722
doi: 10.1016/j.clml.2017.06.022
pubmed: 28709797
Kaseb H, Annamaraju P, Babiker HM (2023) Monoclonal gammopathy of undetermined significance. StatPearls. Treasure Island (FL)
Wadhera RK, Rajkumar SV (2010) Prevalence of monoclonal gammopathy of undetermined significance: a systematic review. Mayo Clin Proc 85(10):933–942
doi: 10.4065/mcp.2010.0337
pubmed: 20713974
Powell FC, Schroeter AL, Su WP, Perry HO (1983) Pyoderma gangrenosum and monoclonal gammopathy. Arch Dermatol 119(6):468–472
doi: 10.1001/archderm.1983.01650300022009
pubmed: 6859886
Daoud MS, Lust JA, Kyle RA, Pittelkow MR (1999) Monoclonal gammopathies and associated skin disorders. J Am Acad Dermatol 40(4):507–535 quiz 36 – 8
doi: 10.1016/S0190-9622(99)70434-2
pubmed: 10188670
Chave TA, Hutchinson PE (2001) Pyoderma Gangrenosum, subcorneal pustular dermatosis, IgA paraproteinaemia and IgG antiepithelial antibodies. Br J Dermatol 145(5):852–854
doi: 10.1046/j.1365-2133.2001.04450.x
pubmed: 11736923
Szalat R, Monsel G, Le Goff W, Battistella M, Bengouffa D, Schlageter MH et al (2015) The spectrum of neutrophilic dermatoses associated with monoclonal gammopathy: Association with IgA isotype and inflammatory profile. J Am Acad Dermatol 73(5):809–820
doi: 10.1016/j.jaad.2015.07.031
pubmed: 26365596
Lipsker D (2017) Monoclonal gammopathy of cutaneous significance: review of a relevant concept. J Eur Acad Dermatol Venereol 31(1):45–52
doi: 10.1111/jdv.13847
pubmed: 27501129
Claveau JS, Wetter DA, Kumar S (2022) Cutaneous manifestations of monoclonal gammopathy. Blood Cancer J 12(4):58
doi: 10.1038/s41408-022-00661-1
pubmed: 35411042
Hoffman KP, Shearer S, Chung C, Kaffenberger JA, Kaffenberger BH (2020) Clinical and therapeutic overlap of pyoderma gangrenosum, cutaneous small vessel vasculitis, and immunoglobulin A. Int J Dermatol 59(8):e286–e8
doi: 10.1111/ijd.14841
pubmed: 32118287
Machan A, Azendour H, Frikh R, Hjira N, Boui M (2020) The dilemma of treating pyoderma gangrenosum associated with monoclonal gammopathy of undetermined significance. Dermatol Online J. 26(5)
Kyle RA, Rajkumar SV (2006) Monoclonal gammopathy of undetermined significance. Br J Haematol 134(6):573–589
doi: 10.1111/j.1365-2141.2006.06235.x
pubmed: 16938117
Weinhold N, Johnson DC, Rawstron AC, Forsti A, Doughty C, Vijayakrishnan J et al (2014) Inherited genetic susceptibility to monoclonal gammopathy of unknown significance. Blood 123(16):2513–2517 quiz 93
doi: 10.1182/blood-2013-10-532283
pubmed: 24449210
Ma L, Xu S, Qu J, Hou J, Wang Y, Wen L et al (2019) Monoclonal gammopathy of undetermined significance in Chinese population: a prospective epidemiological study. Hematol Oncol 37(1):75–79
doi: 10.1002/hon.2548
pubmed: 30117173
Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Offord JR et al (2006) Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med 354(13):1362–1369
doi: 10.1056/NEJMoa054494
pubmed: 16571879
Lecluse Y, Comby E, Mariotte D, Tual S, Le Mauff B, Lebailly P et al (2016) Prevalence of monoclonal gammopathy of undetermined significance (MGUS) among farmers involved in open field farming and/or cattle breading in France. Leuk Lymphoma 57(7):1727–1730
doi: 10.3109/10428194.2015.1113277
pubmed: 26689498
Cabrera Q, Macro M, Hebert B, Cornet E, Collignon A, Troussard X (2014) Epidemiology of Monoclonal Gammopathy of undetermined significance (MGUS): the experience from the specialized registry of hematologic malignancies of Basse-Normandie (France). Cancer Epidemiol 38(4):354–356
doi: 10.1016/j.canep.2014.04.006
pubmed: 24880205
Iwanaga M, Tagawa M, Tsukasaki K, Kamihira S, Tomonaga M (2007) Prevalence of monoclonal gammopathy of undetermined significance: study of 52,802 persons in Nagasaki City, Japan. Mayo Clin Proc 82(12):1474–1479
doi: 10.1016/S0025-6196(11)61090-2
pubmed: 18053454
Kyle RA, Rajkumar SV (2005) Monoclonal gammopathies of undetermined significance. Best Pract Res Clin Haematol 18(4):689–707
doi: 10.1016/j.beha.2005.01.025
pubmed: 16026745
Anagnostopoulos A, Evangelopoulou A, Sotou D, Gika D, Mitsibounas D, Dimopoulos MA (2002) Incidence and evolution of monoclonal gammopathy of undetermined significance (MGUS) in Greece. Ann Hematol 81(7):357–361
doi: 10.1007/s00277-002-0493-0
pubmed: 12185503
Cohen HJ, Crawford J, Rao MK, Pieper CF, Currie MS (1998) Racial differences in the prevalence of monoclonal gammopathy in a community-based sample of the elderly. Am J Med 104(5):439–444
doi: 10.1016/S0002-9343(98)00080-1
pubmed: 9626026
Romanska-Gocka K, Ciescinska C, Zegarska B, Schwartz RA, Ciescinski J, Olszewska-Slonina D et al (2015) Pyoderma gangrenosum with monoclonal IgA gammopathy and pulmonary tuberculosis. Illustrative case and review. Postepy Dermatol Alergol 32(2):137–141
doi: 10.5114/pdia.2014.40974
pubmed: 26015785
pmcid: 4436233
Velasco-Tamariz V, Carreno-Tarragona G, Tous-Romero F, Gil-de la Cruz E, Martin-Clavero E, Rivera-Diaz R (2017) Dramatic resolution of disseminated pyoderma gangrenosum associated with monoclonal gammopathy after therapy with bortezomib and dexamethasone. Int Wound J 14(6):1382–1384
doi: 10.1111/iwj.12746
pubmed: 28371346
Chang CM, Hwang WL, Hsieh ZY, Wang RC, Teng CL (2010) Monoclonal gammopathy of undetermined significance related pyoderma gangrenosum successfully treated with autologous peripheral blood stem cell transplantation. Ann Hematol 89(8):823–824
doi: 10.1007/s00277-009-0880-x
pubmed: 20013121
Binus AM, Qureshi AA, Li VW, Winterfield LS (2011) Pyoderma gangrenosum: a retrospective review of patient characteristics, comorbidities and therapy in 103 patients. Br J Dermatol 165(6):1244–1250
doi: 10.1111/j.1365-2133.2011.10565.x
pubmed: 21824126