= a polyclonal hypergammaglobulinemia
• | episodic showers of petechiae, especially on the legs |
• | SPEP = broad based peak (=polyclonal increase in gamaglobulin (usually IgG) with normal IgM) |
• | associated with autoimmune disease especially Sjogrens syndrome, hepatitis C, multiple myeloma, or idiopathic |
• | course - benign but chronic |
• | measures to obviate stasis are recommended |
• | treatment is often not required except to avoid likely triggers (prolonged standing, exercise) |
clinical ddx: BPP vs. cryoglobulinemia (especially if Schamberg’s in a female) - classically BPP with small ulcers vs.Waldenstrom’s hypergammaglobulinemia Cayenne pepper
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