{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T23:41:23Z","timestamp":1793749283680,"version":"4.6.1"},"reference-count":14,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,3,17]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>A man in his 70s with background vascular disease presented with 7\u2009months of painful non-resolving lower leg ulcers with eschar and petechiae, left lower ear lobe ulceration and dusky inflammation of the right ear. He demonstrated good bilateral pedal pulses and no peripheral oedema. No lymphadenopathy was palpated.<\/jats:p>\n               <jats:p>Biopsy suggested leucocytoclastic vasculitis on chronic stasis changes. Blood investigations showed elevated rheumatoid factor and mixed polyclonal IgG and monoclonal IgM cryoglobulins. He was diagnosed with mixed cryoglobulinaemia, and consequent conducted flow cytometry revealed CD5 +marginal zone lymphoma with elevated serum free light chains and kappa\/lambda ratio.<\/jats:p>\n               <jats:p>One-month following rituximab and chlorambucil therapy, the patient\u2019s pain had much improved, ear ulcers had healed and several leg ulcers had reduced in width and depth. The petechial eruption had also resolved.<\/jats:p>","DOI":"10.1136\/bcr-2021-247780","type":"journal-article","created":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T12:50:15Z","timestamp":1649335815000},"page":"e247780","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Painful ulcerations: the sole clinical sign of mixed cryoglobulinaemia secondary to marginal zone lymphoma"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2346-6773","authenticated-orcid":false,"given":"Christian","family":"Gan","sequence":"first","affiliation":[{"name":"Dermatology, Box Hill Hospital, Box Hill, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7988-7577","authenticated-orcid":false,"given":"Matthew David","family":"Howard","sequence":"additional","affiliation":[{"name":"Dermatology, Box Hill Hospital, Box Hill, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthea","family":"Mulcahy","sequence":"additional","affiliation":[{"name":"Dermatology, Box Hill Hospital, Box Hill, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anousha","family":"Yazdabadi","sequence":"additional","affiliation":[{"name":"Dermatology, Box Hill Hospital, Box Hill, Victoria, Australia"},{"name":"Melbourne University, The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,4,7]]},"reference":[{"key":"2025082707282620000_15.4.e247780.1","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.jbspin.2019.01.016","article-title":"Cryoglobulinemia: an update in 2019","volume":"86","author":"Desbois","year":"2019","journal-title":"Joint Bone Spine"},{"key":"2025082707282620000_15.4.e247780.2","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.autrev.2017.11.035","article-title":"Cryoglobulins: an update on detection, mechanisms and clinical contribution","volume":"17","author":"Kolopp-Sarda","year":"2018","journal-title":"Autoimmun Rev"},{"key":"2025082707282620000_15.4.e247780.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.02.017"},{"key":"2025082707282620000_15.4.e247780.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2003.10.001"},{"key":"2025082707282620000_15.4.e247780.5","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.1.101"},{"key":"2025082707282620000_15.4.e247780.6","doi-asserted-by":"publisher","DOI":"10.1177\/003693308803300413"},{"key":"2025082707282620000_15.4.e247780.7","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2230.2003.01189.x"},{"key":"2025082707282620000_15.4.e247780.8","doi-asserted-by":"crossref","DOI":"10.1100\/tsw.2008.44","article-title":"Essential type II mixed cryoglobulinemia causing pyoderma gangrenosum-like ulcers","volume":"8","author":"Namazi","year":"2008","journal-title":"ScientificWorldJournal"},{"key":"2025082707282620000_15.4.e247780.9","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jbspin.2014.05.005","article-title":"Severe skin involvement in type II cryoglobulinemia successfully treated with thalidomide","volume":"82","author":"Taraborelli","year":"2015","journal-title":"Joint Bone Spine"},{"key":"2025082707282620000_15.4.e247780.10","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.19.2101"},{"key":"2025082707282620000_15.4.e247780.11","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.100898"},{"key":"2025082707282620000_15.4.e247780.12","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e318288925c"},{"key":"2025082707282620000_15.4.e247780.13","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(80)90390-3"},{"key":"2025082707282620000_15.4.e247780.14","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-12-396028"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-247780","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:28:32Z","timestamp":1756304912000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-247780"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4]]},"references-count":14,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,7]]},"published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1136\/bcr-2021-247780"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-247780","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4]]}}}