{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:05:21Z","timestamp":1760234721394,"version":"build-2065373602"},"reference-count":8,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>An 83-year-old woman was admitted to the emergency department for a 7-day history of fatigue and progressive cyanosis in the feet and hands after cold exposure despite physical protective measures. Upon arrival, the patient presented with necrotic cutaneous lesions in both hands and distal lower extremities. Upon admission, hemoglobin was 7.6 g\/dL and laboratory tests were consistent with cold agglutinin disease (CAD), the presence of monoclonal IgM, and flow cytometry consistent with lymphoplasmacytic lymphoma, but MYD88 L265P mutation was negative. The patient required blood transfusion, resulting in stabilized hemoglobin and a decrease in markers of hemolysis. Treatment with aspirin 250 mg daily and intravenous iloprost 0.5 mL\/h was initiated with a poor clinical response at day 4. Amputation was required. Plasma exchange was performed and chemotherapy with rituximab and bendamustine was initiated. The clinical course was marked by further necrosis, prompting discussions regarding an additional amputation that was not performed considering the high surgical risk and refusal by the patient. Supportive treatment was initiated, and the patient expired one month after hospital admission.<\/jats:p>","DOI":"10.3390\/medicina57060592","type":"journal-article","created":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T12:08:55Z","timestamp":1623154135000},"page":"592","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Frostbite and Cold Agglutinin Disease: Coexistence of Two Entities Leading to Poor Clinical Outcomes"],"prefix":"10.3390","volume":"57","author":[{"given":"Noel","family":"Lorenzo-Villalba","sequence":"first","affiliation":[{"name":"Service de M\u00e9decine Interne, Diab\u00e8te et Maladies M\u00e9taboliques, H\u00f4pitaux Universitaires de Strasbourg, 67000 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7914-7616","authenticated-orcid":false,"given":"Emmanuel","family":"Andres","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Diab\u00e8te et Maladies M\u00e9taboliques, H\u00f4pitaux Universitaires de Strasbourg, 67000 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Guerrero-Ni\u00f1o","sequence":"additional","affiliation":[{"name":"Service des Urgences, H\u00f4pitaux Universitaires de Strasbourg, 67000 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Nasco","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Diab\u00e8te et Maladies M\u00e9taboliques, H\u00f4pitaux Universitaires de Strasbourg, 67000 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessy","family":"Cattelan","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Diab\u00e8te et Maladies M\u00e9taboliques, H\u00f4pitaux Universitaires de Strasbourg, 67000 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier","family":"Jannot","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Diab\u00e8te et Maladies M\u00e9taboliques, H\u00f4pitaux Universitaires de Strasbourg, 67000 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Pierre","family":"Ledoux","sequence":"additional","affiliation":[{"name":"Service d\u2019H\u00e9matologie, H\u00f4pitaux Universitaires de Strasbourg, 67000 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"93","DOI":"10.2147\/JBM.S177621","article-title":"Cold agglutinin disease: Current challenges and future prospects","volume":"10","author":"Berentsen","year":"2019","journal-title":"J. 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