Description
A 60-year-old Caucasian man with untreated chronic lymphocytic leukaemia presented with a 3-month history of recurrent arthralgia and joint swelling, predominantly affecting the knee, wrist and DIP joints. He subsequently developed painful, dusky fingers and was referred to the haematology department at the Royal Free Hospital for investigation (figure 1).
On admission, a full blood count revealed: Hb 92 g/L, white cell count 86.7x109/L with a lymphocyte differential of 77.2x109/L and platelets 332. Renal, liver and bone profiles within normal ranges. Cryoglobulins were detected, and subsequent immunofixation showed the presence of a type 1, monoclonal IgM lambda cryoglobulin.
Figure 1
Before treatment.
The patient was managed with a continuous iloprost infusion, high dose corticosteroid therapy, plasmapharesis, rituximab and subsequently a dose of cyclophosphamide. On discharge, he was referred to University College Hospital for long-term management of CLL. He was referred...
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