Rivat M H, Colomb D, Normand J, Cavailles M
Ann Dermatol Venereol. 1979 Oct;106(10):755-66.
A case of diffuse plane xanthomatosis assoicated with systemic amyloidosis and multiple myeloma at its outset is reported. Plane xanthomatosis is certainly an autonomous entity in comparison with systemic amyloidosis, for there are no amyloid deposits in xanthoma. The patient had lambda type IgG paraproteinemia, with Bence-Jones proteinuria. Lipid tests were considered as normolipemic though some levels recall a type IV hyperlipoproteinaemia. A review of literature about the association "xanthomatosis-multiple myeloma" was made, after the important work of Bazex, Dupré and Mrs. Christol-Jalby. It allows us to distinguish two differnet descriptions: 1. When there is hyperlipoproteinemia, all clinical types of xanthomas may exist; multiple myeloma is generally typical (but sometimes not very progressive). 2. When there is normolipidemia, the main clinical type is diffuse plane xanthomatosis; multiple myeloma is atypical and often only a monoclonal gammapathy is found. 3. However in both cases, the outstanding clinical type is diffuse plane xanthomatosis: whether normo- or hyperlipemic, this therefore indicates a possible underlying disease, and above all a multiple myeloma.
报告了一例最初表现为弥漫性扁平黄瘤病伴系统性淀粉样变性和多发性骨髓瘤的病例。与系统性淀粉样变性相比,扁平黄瘤病无疑是一种独立的疾病实体,因为在黄瘤中不存在淀粉样沉积物。该患者存在λ型IgG副蛋白血症及本周蛋白尿。尽管某些血脂水平提示为IV型高脂蛋白血症,但血脂检查仍被认为是正常血脂。在Bazex、Dupré以及Christol-Jalby夫人的重要研究之后,对“黄瘤病-多发性骨髓瘤”关联的文献进行了综述。这使我们能够区分两种不同的描述:1. 当存在高脂蛋白血症时,可能存在所有临床类型的黄瘤;多发性骨髓瘤通常是典型的(但有时进展不明显)。2. 当存在正常血脂时,主要临床类型是弥漫性扁平黄瘤病;多发性骨髓瘤是非典型的,通常仅发现单克隆丙种球蛋白病。3. 然而在这两种情况下,突出的临床类型都是弥漫性扁平黄瘤病:无论血脂正常或升高,这都提示可能存在潜在疾病,尤其是多发性骨髓瘤。