Digital Necrosis as Initial Manifestation of Multiple Myeloma: An Unusual Case Report

Clinical manifestations of multiple myeloma are variable. The authors report a 68-year-old female who presented to the hospital with bilateral digital necrosis and dry gangrenous toes in both left and right feet. She was diagnosed with IgA-λ multiple myeloma associated with Type I cryoglobulinaemia. Emergency management consisted in hyperhydration (plasmapheresis was not available) and thromboprophylaxis. Necrotic digits were amputated. Chemotherapy (bortezomib, lenalidomide, and dexamethasone) was started with good initial evolution. This uncommon presentation can easily be missed, and clinicians should be aware of a possible underlying malignancy.