LAUSR

A 62-year-old woman presented with numbness, tingling, and an asymptomatic rash on the bilateral lower extremities. She had a history of recently diagnosed untreated multiple myeloma. Physical examination found decreased sensation over the bilateral feet and symmetric, violaceous, reticular patches over the bilateral lower extremities (Fig 1). Laboratory studies found a monoclonal IgG k gammopathy and elevated serum viscosity elevation to 2.0 centipoises. Rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibody, antiphospholipid antibodies, and hepatitis serologies were negative. Skin biopsy found subcuticular vessels with intimal hyperplasia, increased reactive small vessels, and hemosiderin deposition suggestive of prior vascular thrombosis and no associated vasculitis (Fig 2).