{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:48:48Z","timestamp":1764874128974,"version":"3.41.2"},"reference-count":12,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec><jats:title>Key Clinical Message<\/jats:title><jats:p>We report an observation of a young patient presenting with severe type 1 cryoglobulinemic vasculitis revealing a monoclonal gammopathy of clinical significant. Treatment with Melphalan\u2010Thalidomide Prednisone improved the symptoms. Early diagnosis would prevent serious tissue damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>Monoclonal gammopathy encompass diverse clinical forms. Only the cancerous form, multiple myeloma (MM), is treated based on specific diagnostic criteria. A new clinical entity, monoclonal gammopathy of clinical significance (MGCS), warrants special attention due to its need for specific treatment. It involves patients with signs of potentially severe organ involvement that do not meet MM criteria. We present the case of a 34\u2010year\u2010old Malagasy woman with severe type I cryoglobulinemic vasculitis associated with noncancerous monoclonal gammopathy, showing a favorable outcome after treatment with Thalidomide. Symptoms included toe necrosis, a severe ulcer on the left calf evolving for 3\u2009months, and stocking\u2010like dysesthesias. Investigations revealed monoclonal gammopathy at 30.1\u2009g\/L, proteinuria at 1\u2009g\/24\u2009h, medullary plasma cell at 6%, and circulating cryoglobulin of Ig kappa type. CRAB criteria (anemia, hypercalcemia, renal insufficiency, and osteolysis) were absent. Treatment with Thalidomide, combined with corticosteroids and local care for 4\u2009months, resulted in ulcer healing, disappearance of dysesthesias, and persistent normalization of gammaglobulin. Our case underscores the importance of specific treatment for MGCS.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.8897","type":"journal-article","created":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T03:44:42Z","timestamp":1716954282000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Monoclonal gammopathy of clinical significance in a young patient treated with melphalan\u2010thalidomide\u2010prednisone"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1851-6518","authenticated-orcid":false,"given":"Oliva Henintsoa","family":"Rakotonirainy","sequence":"first","affiliation":[{"name":"Rheumatology Department CHU Befelatanana  Antananarivo Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lalao Nomenjanahary","family":"Rakotonirina","sequence":"additional","affiliation":[{"name":"Rheumatology Department CHU Befelatanana  Antananarivo Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stevy","family":"Desana","sequence":"additional","affiliation":[{"name":"Dermatology Department CHU Befelatanana  Antananarivo Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laur\u00e9at Brunda","family":"Manahandray","sequence":"additional","affiliation":[{"name":"Internal Medicine Department CHU Befelatanana  Antananarivo Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2533-1530","authenticated-orcid":false,"given":"Rajo Pa\u00efdia","family":"Radinasoa","sequence":"additional","affiliation":[{"name":"Internal Medicine Department CHU Befelatanana  Antananarivo Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tahinasoa","family":"Randriamampianina","sequence":"additional","affiliation":[{"name":"Clinical Hematology Department CHU HJRA  Antananarivo Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahafahantsoa Rapelanoro","family":"Rabenja","sequence":"additional","affiliation":[{"name":"Dermatology Department CHU Befelatanana  Antananarivo Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-021-00406-6"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-020-01051-x"},{"issue":"4","key":"e_1_2_13_4_1","first-page":"556","article-title":"Severe Cryoglobulinemic vasculopathy and underlying monoclonal Gammopathy: the importance of identifying and targeting the underlying plasma cell clone in diagnosis and treatment","volume":"5","author":"Leypoldt LB","year":"2021","journal-title":"Arch Clin Biomed Res [Internet]"},{"issue":"4","key":"e_1_2_13_5_1","first-page":"191","article-title":"Monoclonal gammopathy with significance: case series and literature review","volume":"78","author":"Schoot TS","year":"2020","journal-title":"Neth J Med"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0b013e3182155e8d"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-04-839480"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-12-539940"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/HS9.0000000000000908"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e318288925c"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-09-719773"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13205131"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24745"}],"container-title":["Clinical Case 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