Cryoglobulinaemic leg ulcers associated with transient ischaemic attack.

This study report an 87-year-old male patient with multiple, superficial non-healing leg ulcers and transient ischaemic attack. Testing for serum cryoglobulins returned positive and for serum immunofixation electrophoresis displayed increased monoclonal IgG-kappa. Histological examination revealed epidermis ulceration, accumulations of neutrophils with nuclear dust or debris (leukocytoclasia) and PAS positive homogen eosinophilic fibrin deposition in the vessel wall. Leucocytoclastic vasculitis was diagnosed pathologically. Direct immunofluorescence testing was performed for confirmation of the diagnosis of cutaneous vasculitis, with intravascular deposition of IgA, IgG, IgM and C3 in the walls of vessels of papillary and reticular dermis. There was no underlying disease and the patient was diagnosed with cryoglobulinaemia type I. Leg ulcers responded successfully to treatment with high dose steroids and anticoagulant agents and healed within 2 months.