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interstitial pneumonia&#44; and nephropathy&#44; though histopathological confirmation was not available in most cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;8</span></a> Patients with systemic involvement can show constitutional symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3&#44;7&#8211;9</span></a> Often&#44; polyclonal hypergammaglobulinemia can appear&#44; mainly of IgG and IgA&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;10</span></a> Our patient&#44; however&#44; had an IgM deficit that we did not consider to be clinically relevant&#46; Anemia and increased erythrocyte sedimentation rate or total serum proteins have also been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Histologically&#44; skin lesions are characterized by a periadnexal and perivascular dermal infiltrate of mature&#44; polyclonal plasma cells&#44; without atypia&#44; and with a variable number of lymphocytes and histiocytes&#44; generally without epidermal involvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinically&#44; involvement on the trunk can be confused with acne&#44; lichen planus&#44; lymphomas&#44; mastocytosis&#44; parapsoriasis&#44; pityriasis rosea or postinflammatory hyperpigmentation&#44; and facial involvement with rosacea or lupus erythematosus&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7&#44;9</span></a> Histologically&#44; it is necessary to differentiate this condition from other cutaneous infiltrates of plasma cells such as malignant proliferations which are monoclonal &#40;plasmacytoma&#44; B-cell lymphomas&#44; and leukemia cutis in plasma cell leukemias&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> connective tissue disorders &#40;morphea&#44; lupus&#41;&#44; and infections &#40;syphilis&#44; borreliosis&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Its pathogenesis is unknown&#46; Proliferation of plasma cells seems to be a reactive process&#44; and the higher incidence in Japanese individuals suggests that environmental&#44; genetic&#44; or infectious factors are present&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;8</span></a> Elevated interleukin &#40;IL&#41; 6 is reported in 75&#37; of patients with cutaneous and systemic plasmacytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> This cytokine induces differentiation of B lymphocytes to plasma cells&#46; IL-6 is also elevated in multicentric Castleman disease &#40;MCD&#41;&#44; which has led some authors to consider cutaneous and systemic plasmacytosis as one of its variants&#46; However&#44; generally&#44; this increase in MCD appears to result from HHV-8 infected cells&#44; whereas this virus has not been detected in cutaneous and systemic plasmacytosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;6&#8211;9</span></a> Our patient had normal IL-6 serum and negative polymerase chain reaction for HHV-8&#46; It has recently been suggested that IgG<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> could play a role in the pathogenesis of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Cutaneous plasmacytosis normally follows a chronic&#44; benign course&#44; without spontaneous remission&#44; although cases of patients with systemic plasmacytosis who developed respiratory or renal failure and association with certain tumors&#44; such as T-cell lymphoma&#44; have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;5&#44;7&#44;9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Multiple treatments have been reported &#40;corticosteroids&#44; topical immunomodulators&#44; antibiotics&#44; psoralen and ultraviolet A radiation&#44; lasers&#44; radiotherapy&#44; thalidomide&#44; immunoglobulins&#44; rituximab&#44; chemotherapy&#41; with limited response&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3&#44;5&#8211;9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">We presented a case of cutaneous plasmacytosis without any evidence of systemic involvement to date&#46; We consider the case of interest given the low incidence of the disease in white individuals&#46;</p></span>"
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Case and Research Letters
Cutaneous Plasmacytosis in a White Man
Plasmocitosis cutánea en un varón de raza blanca
A. López-Gómeza,
Autor para correspondencia
Alizia_lg@hotmail.com

Corresponding author.
, T. Salas-Garcíaa, A. Ramírez-Andreoa, E. Poblet-Martínezb
a Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, Spain
b Servicio de Anatomía Patológica, Hospital General Universitario Reina Sofía, Murcia, Spain
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Serology for syphilis&#44; hepatitis B virus&#44; hepatitis C virus&#44; human immunodeficiency virus&#44; and <span class="elsevierStyleItalic">Borrelia burgdorferi</span> were negative&#46; The Mantoux test was positive&#44; although we later learned that the patient had received antituberculosis treatment in childhood&#46; Levels of serum proteins and electrophoresis were normal&#46; Determination of immunoglobulin &#40;Ig&#41; by centrifugation revealed slightly decreased IgM&#44; with normal levels of IgG&#44; subclasses of IgG&#44; and IgA&#46; We did not detect Bence Jones proteinuria or free light chains in urine&#46; Histochemical study of the second sample showed predominance of plasma cells &#40;CD138&#43;&#41;&#44; which expressed both light Ig chains&#44; demonstrating the polyclonality of the infiltrate&#44; and a normal number of mastocytes &#40;ckit&#43;&#41;&#46; Congo red staining ruled out the presence of amyloid deposits&#46; In view of the above findings&#44; cutaneous plasmacytosis was diagnosed and a chest-abdominal-pelvic computed tomography study was requested along with bone marrow biopsy&#44; though no signs of extracutaneous infiltration were detected&#46; IL-6 serum was normal&#44; and the polymerase chain reaction assay for human herpes virus-8 &#40;HHV-8&#41; was negative&#46; The patient has been in clinical&#44; laboratory&#44; and radiological follow-up for 2&#46;5 years&#44; during which time he has remained stable without treatment and without spread of the disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Cutaneous and systemic plasmacytosis is a rare lymphoplasmacytic disorder of unknown cause&#44; reported mainly in middle-aged Japanese men&#59; 11 cases have been reported in the white population&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;9</span></a> Kimura<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> coined the term cutaneous plasmacytosis&#44; 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interstitial pneumonia&#44; and nephropathy&#44; though histopathological confirmation was not available in most cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;8</span></a> Patients with systemic involvement can show constitutional symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3&#44;7&#8211;9</span></a> Often&#44; polyclonal hypergammaglobulinemia can appear&#44; mainly of IgG and IgA&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;10</span></a> Our patient&#44; however&#44; had an IgM deficit that we did not consider to be clinically relevant&#46; Anemia and increased erythrocyte sedimentation rate or total serum proteins have also been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Histologically&#44; skin lesions are characterized by a periadnexal and perivascular dermal infiltrate of mature&#44; polyclonal plasma cells&#44; without atypia&#44; and with a variable number of lymphocytes and histiocytes&#44; generally without epidermal involvement&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinically&#44; involvement on the trunk can be confused with acne&#44; lichen planus&#44; lymphomas&#44; mastocytosis&#44; parapsoriasis&#44; pityriasis rosea or postinflammatory hyperpigmentation&#44; and facial involvement with rosacea or lupus erythematosus&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7&#44;9</span></a> Histologically&#44; it is necessary to differentiate this condition from other cutaneous infiltrates of plasma cells such as malignant proliferations which are monoclonal &#40;plasmacytoma&#44; B-cell lymphomas&#44; and leukemia cutis in plasma cell leukemias&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> connective tissue disorders &#40;morphea&#44; lupus&#41;&#44; and infections &#40;syphilis&#44; borreliosis&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Its pathogenesis is unknown&#46; Proliferation of plasma cells seems to be a reactive process&#44; and the higher incidence in Japanese individuals suggests that environmental&#44; genetic&#44; or infectious factors are present&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;8</span></a> Elevated interleukin &#40;IL&#41; 6 is reported in 75&#37; of patients with cutaneous and systemic plasmacytosis&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> This cytokine induces differentiation of B lymphocytes to plasma cells&#46; IL-6 is also elevated in multicentric Castleman disease &#40;MCD&#41;&#44; which has led some authors to consider cutaneous and systemic plasmacytosis as one of its variants&#46; However&#44; generally&#44; this increase in MCD appears to result from HHV-8 infected cells&#44; whereas this virus has not been detected in cutaneous and systemic plasmacytosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;6&#8211;9</span></a> Our patient had normal IL-6 serum and negative polymerase chain reaction for HHV-8&#46; It has recently been suggested that IgG<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> could play a role in the pathogenesis of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Cutaneous plasmacytosis normally follows a chronic&#44; benign course&#44; without spontaneous remission&#44; although cases of patients with systemic plasmacytosis who developed respiratory or renal failure and association with certain tumors&#44; such as T-cell lymphoma&#44; 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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#243;pez-G&#243;mez A&#44; Salas-Garc&#237;a T&#44; Ram&#237;rez-Andreo A&#44; Poblet-Mart&#237;nez E&#46; Plasmocitosis cut&#225;nea en un var&#243;n de raza blanca&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;520&#8211;522&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Multiple papules distributed symmetrically on the trunk and tops of the limbs of the patient&#46; B&#44; Detail of the lesions&#58; rounded or ovulated&#44; nonscaling&#44; nonconfluent brown-red papules with well-defined borders&#44; measuring up to 6<span class="elsevierStyleHsp" style=""></span>mm&#46;</p>"
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        "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">We would like to thank Jes&#250;s Hern&#225;ndez-Gil S&#225;nchez for his collaboration in drafting the article&#46;</p>"
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