NAG-1/GDF-15 Transgenic Female Mouse Shows Delayed Peak Period of the Second Phase Nociception in Formalin-induced Inflammatory Pain

Non-steroidal anti-inflammatory drug-activated gene-1 (NAG-1), also known as growth differentiation factor-15 (GDF-15), is associated with cancer, diabetes, and inflammation, while there is limited understanding of the role of NAG-1 in nociception. Here, we examined the nociceptive behaviors of NAG-1 transgenic (TG) mice and wild-type (WT) littermates. Mechanical sensitivity was evaluated by using the von Frey filament test, and thermal sensitivity was assessed by the hot-plate, Hargreaves, and acetone tests. c-Fos, glial fibrillary acidic protein (GFAP), and ionized calcium binding adaptor molecule-1 (Iba-1) immunoreactivity was examined in the spinal cord following observation of the formalin-induced nociceptive behaviors. There was no difference in mechanical or thermal sensitivity for NAG-1 TG and WT mice. Intraplantar formalin injection induced nociceptive behaviors in both male and female NAG-1 TG and WT mice. The peak period in the second phase was delayed in NAG-1 TG female mice compared with that of WT female mice, while there was no difference in the cumulative time of nociceptive behaviors between the two groups of mice. Formalin increased spinal c-Fos immunoreactivity in both TG and WT female mice. Neither GFAP nor Iba-1 immunoreactivity was increased in the spinal cord of TG and WT female mice. These findings indicate that NAG-1 TG mice have comparable baseline sensitivity to mechanical and thermal stimulation as WT mice and that NAG-1 in female mice may have an inhibitory effect on the second phase of inflammatory pain. Therefore, it could be a novel target to inhibit central nervous system response in pain.

Agreement between Two Swept-Source Optical Coherence Tomography Biometers and a Partial Coherence Interferometer

Purpose@#To evaluate the level of agreement between ANTERION (Heidelberg Engineering, Heidelberg, Germany), OA-2000 (Tomey, Nagoya, Japan), and IOLMaster 500 (Carl Zeiss AG, Jena, Germany). @*Methods@#Fifty-one eyes of 51 patients were included in the study. Flat keratometry (K) and steep K, vector component of astigmatism (Jackson cross-cylinder at 0° and 90° [J0] and Jackson cross-cylinder at 45° and 135° [J45]), anterior chamber depth, and axial length were compared using the three devices. Repeated measures analysis of variance was conducted to compare the mean values of the biometrics. Pearson correlation test was conducted to analyze the correlations of the measured values, and a Bland-Altman plot was used to assess the agreement between the three devices. The predicted intraocular lens power of each device was compared to the others using the SRK/T, Haigis, Barrett Universal II, and Kane formulas. @*Results@#All K values measured using ANTERION were flatter than those of other instruments. However, good agreement was observed for flat K (ANTERION - OA-2000; 95% limits of agreement [LoA], 0.86 diopters [D]) and steep K (ANTERION - OA2000; 95% LoA, 0.93 D) and OA-2000 - IOLMaster 500 (95% LoA, 0.93 D). J0 and J45 vector components of astigmatism were not statistically different; however, the agreements were poor between the devices (95% LoA ≥1.97 D). Anterior chamber depth values of ANTERION and OA-2000 were interchangeable (95% LoA, 0.15 mm). The axial length showed a high agreement (95% LoA ≤0.17 mm) among the three devices. The predicted intraocular lens powers of the three devices were not interchangeable regardless of formulas (95% LoA ≥1.04 D). @*Conclusions@#Significant differences in ocular biometrics were observed between ANTERION and the other two devices. This study demonstrated that only axial length showed good agreement among devices.

Methylprednisolone versus intravenous immune globulin as an initial therapy in adult primary immune thrombocytopenia

BACKGROUND/AIMS@#Few studies have addressed whether there are differences in clinical efficacy between intravenous methylprednisolone (methyl-Pd) and intravenous immunoglobulin (IVIg) use.@*METHODS@#We retrospectively compared platelet responses and toxicities associated with these two treatments in adult patients with immune thrombocytopenia. Patients received intravenous methyl-Pd therapy followed by oral prednisolone (Pd) from 1993 to 2002 and IVIg together with oral Pd from 2003 to 2008.@*RESULTS@#Early response and maintenance of the response were assessed at 7 days and 6 months after treatment, respectively. Of the 87 patients enrolled, 77 (88.5%) were eligible for analysis. Early responses occurred in 30 of 39 patients (76.9%) receiving methyl-Pd versus 33 of 38 patients (86.6%) receiving IVIg (p = 0.187). The response was maintained in 28 patients (71.8%) in the methyl-Pd arm and in 23 patients (60.5%) in the IVIg arm (p = 0.187). The time to a complete response in the IVIg arm (6 days; range, 1 to 35) was shorter than that in the methyl-Pd arm (13.5 days; range, 2 to 29) (p = 0.002). Side effects were mild and tolerable in both arms. Five years after initiating treatment, 7 of 18 patients (38.9%) and five of 14 patients (35.7%) were still maintaining a response in the methyl-Pd and IVIg arms, respectively.@*CONCLUSIONS@#These results indicate that neither the early response rate nor the long-term outcome differed between the methyl-Pd and IVIg treatments. However, IVIg induced a complete response more rapidly than did methyl-Pd.

Determinants of Health in Korea: A Comparative Analysis among Organization for Economic Cooperation and Development Countries / 보건행정학회지

BACKGROUND: This study aims to utilize Organization for Economic Cooperation and Development (OECD) data to identify macroscopic determinants of health at national level and to utilize it in health policy development through comparison and analysis with Korea. METHODS: The potential years of life lost (PYLL) were used as dependent variables and 19 indicators were selected as health determinants to be independent variables based on the results of previous studies. Data analysis was done using SAS ver. 9.4 package (SAS Institute Inc., Cary, NC, USA) and model used in technical statistics concerning PYLL by countries, multi-linearity test between independent variables and OECD economic studies were modified and used. RESULTS: From 1994 to 2012, the average PYLL for OECD countries was 4,262.9 years, the highest in Estonia and the lowest in Iceland. As a result of the analysis using the fixed effect model, the significant variables affecting PYLL were four variables: gross domestic product, nitric oxide, tobacco consumption, and number of doctors. The health determinants that had more influence on the PYLL of Korean people compared to other OECD countries were tobacco consumption, calorie consumption, fat intake and total health expenditure. CONCLUSION: In order to effectively reduce unnecessary deaths, we must continue to strengthen our smoking policy and nutrition policies such as calorie and fat intake. It is necessary to prevent the increase of total health expenditure due to the increase in the prevalence of chronic diseases and to strengthen the public health aspect.

Chronic kidney disease in the BCR-ABL1-negative myeloproliferative neoplasm: a single-center retrospective study

BACKGROUND/AIMS: Renal complications related to BCR-ABL1-negative myeloproliferative neoplasms (MPNs) have not been examined fully in Asian populations. METHODS: We analyzed estimated glomerular filtration rate (eGFR) and its changes with time retrospectively in patients with BCR-ABL1-negative MPN from 2005 to 2015. RESULTS: The prevalence of chronic kidney disease (CKD) was 11% (6.6% having stage 3 and 4.4% having stage 4). In a linear regression analysis of eGFR versus time (years), overall, patients showed increased eGFR (mL/min/1.73 m2) by 0.51 (95% confidence interval [CI], –0.30 to 1.33; p = 0.22). Patients with polycythemia vera (PV), and those treated with hydroxyurea, showed statistically significant increases in eGFR (1.59; 95% CI, 0.28 to 2.90; p = 0.22 in PV; and 1.55; 95% CI, 0.56 to 2.54; p = 0.22 in treatment with hydroxyurea). In total, 17 patients (20.5%) showed rapid loss of eGFR (7.0 × 109 /L) and high monocyte (> 0.7 × 109 /L) counts (76.5% vs. 50%, p=0.05; 52.9% vs. 28.8%, p= 0.06, respectively). More patients had high serum lactate dehydrogenase (> 500 U/L) levels (52.9% vs. 25.8%, p = 0.03) at diagnosis. CONCLUSIONS: CKD is prevalent in patients with BCR-ABL1-negative MPN. Active cytoreductive therapy has the potential to improve kidney function in BCR-ABL1-negative MPN.

Low-dose prednisolone in patients with paroxysmal nocturnal hemoglobinuria and inadequate response to eculizumab

No abstract available.

Two Cases of Intravascular Lymphoma Presenting with Pulmonary Involvement

No abstract available.

Comparison of the Level and Side Effects of Spinal Anesthesia with Hyperbaric Bupivacaine in the Supine, Lateral, and Prone Positions

PURPOSE: This study attempted to test whether there are differences in the level and hemodynamic side effects (blood pressure, heart rate, O2 saturation), and nausea & vomiting of spinal anesthesia using hyperbaric bupivacaine according to position (supine, lateral, and prone positions) in orthopedic surgery patients who received podiatric surgery under spinal anesthesia. METHODS: This study was conducted with 53 patients who had received orthopedic surgery under spinal anesthesia at I General Hospital. Data were analyzed using SPSS 20.0 through repeated-measures ANOVA, post-hoc test, Chi-test, and Fisher's exact test. RESULTS: The change of position after spinal anesthesia with hyperbaric bupivacaine caused a change in the level of spinal anesthesia (F=12.768, p<.001). However, no difference of blood pressure, heart rate, O2 saturation and nausea and vomiting caused by the change in anesthesia level was observed, and in prone position, drug was administered for the correction of side effects. CONCLUSION: As expected, recognizing that there can be a change in the level of spinal anesthesia after the change of position in surgical patients, nurse anesthetists should monitor their conditions carefully and continuously.

Bortezomib inhibits the survival and proliferation of bone marrow stromal cells

BACKGROUND: Bortezomib is widely used for the treatment of multiple myeloma. Bone marrow stromal cells (BMSCs) endow myeloma cells with survival and growth advantages. However, the influence of bortezomib on BMSCs is not well elucidated. We examined the effects of bortezomib on the survival and growth of BMSCs in vitro. METHODS: The effects of bortezomib on the survival and proliferation of the BMSC MS-5 cell line and on BMSCs obtained from healthy individuals (N=4) and newly diagnosed myeloma patients (N=5) were investigated in vitro. Transmembrane cell migration was evaluated using the Transwell system. A short interfering RNA strategy was used to knock down the expression of chemokine (CXC motif) ligand 12 (CXCL12) mRNA. To examine the effects of bortezomib-exposed BMSCs on the migration and localization of myeloma cells, MS-5 monolayers were treated with bortezomib for 24 hr, washed, and then overlaid with human RPMI8226 myeloma cells. RESULTS: Bortezomib inhibited BMSC proliferation in a concentration-dependent manner, and induced cellular apoptosis. Bortezomib decreased CXCL12 production by BMSCs. Knockdown of CXCL12 mRNA in BMSCs revealed that CXCL12 served as an autocrine growth factor. Short-term bortezomib treatment of BMSC monolayers reduced the tendency of myeloma cells to locate to positions under the monolayers. CONCLUSION: Bortezomib inhibits the survival and growth of BMSCs via downregulation of CXCL12, which may contribute to the clinical effects of this agent.

The Efficacy and Safety of Platinum/Vinorelbine as More Than Second-Line Chemotherapy for Advanced Non-small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There is no regimen that is strongly recommended for more than second-line treatment. We investigated the efficacy and safety of platinum/vinorelbine as more than second-line treatment. MATERIALS AND METHODS: We selected patients with advanced non-small cell lung cancer (NSCLC) who received treatment with platinum/vinorelbine at Chungnam National University Hospital from August 2001 to December 2013. The primary end point was the response rate, and secondary end points were progression-free survival (PFS), overall survival (OS), and toxicity. RESULTS: Thirty-five patients were enrolled. Response rate was 22.9% (complete response, 0 patients [0%]; partial response, eight patients [22.9%]; stable disease, 10 patients [28.6%]; progressive disease, 14 patients [40.0%]). A significantly higher response rate was observed for patients who had responded to previous chemotherapy than for those who did not (34.8% [8/23] vs. 0% [0/12], p=0.020). The median PFS was 4 months (range, 1 to 21 months). Patients with adenocarcinoma and non-smokers had a significantly longer PFS than patients with non-adenocarcinoma and smokers (5 months vs. 2 months, p=0.007; 4.5 months vs. 2 months, p=0.046, respectively). The median OS was 10 months (range, 1 to 41 months). Patients with good performance status and non-smokers had a significantly longer OS than patients with poor performance status and smokers (14 months vs. 4 months, p=0.02; 18.5 months vs. 6 months, p=0.049, respectively). The main serious adverse event (grade 3 or 4) was neutropenia (15 events, 13.3%) in a total of 113 cycles. CONCLUSION: Platinum/vinorelbine was effective as more than second-line chemotherapy, and the toxicity was tolerable, in patients with advanced NSCLC.

Expression and functional roles of the chemokine receptor CXCR7 in acute myeloid leukemia cells

BACKGROUND: The C-X-C chemokine receptor 7 (CXCR7) has been shown to be a decoy receptor for CXCR4 in certain cell types. We investigated the expression status and functional roles of CXCR7 in acute myeloid leukemia (AML) cells in vitro. METHODS: CXCR7 mRNA was knocked down in AML cells by using small interfering RNA (siRNA) technology, and subsequent biological alterations in the cells were evaluated in vitro. RESULTS: All AML cell lines examined in this study (U937, K562, KG1a, HL-60, and MO7e) and primary CD34+ cells obtained from patients with AML expressed CXCR7 mRNA at various levels. Western blotting showed that all AML cells produced CXCR7. Furthermore, all AML cells expressed CXCR7 in both the cytoplasm and on the cell surface at various levels. Stromal cell-derived factor-1 (SDF-1; C-X-C motif ligand 12 (CXCL12)) induced internalization of cell surface CXCR7. However, neither hypoxia nor the examined hematopoietic growth factors (interleukin-1beta (IL-1beta), IL-3, IL-6, granulocyte-colony-stimulating factor, granulocyte, macrophage-colony-stimulating factor, and stem cell factor) and proinflammatory cytokines (interferon-gamma, transforming growth factor-beta, and tumor necrosis factor-alpha) were found to alter cell surface CXCR7 expression. The transfection of AML cells with CXCR4 siRNA, but not CXCR7 siRNA, significantly impaired the CXCL12-induced transmigration of the cells. The transfection of AML cells with CXCR7 siRNA did not affect the survival or proliferation of these cells. Knockdown of CXCR7, but not CXCR4, induced the upregulation of CXCL12 mRNA expression and CXCL12 production in AML cells. CONCLUSION: CXCR7 is involved in the regulation of autocrine CXCL12 in AML cells.

Successful Transcatheter Embolization of Spontaneous Splenic Rupture in a Patient with Chronic Myeloid Leukemia / 대한내과학회지

We report a rare case of a patient who presented with pathological splenic rupture as the initial manifestation of chronic myeloid leukemia (CML) and was treated successfully by transcatheter arterial embolization. A 36-year-old man presented to the emergency department with a 1-day history of abdominal pain. Computed tomography showed gross hemoperitoneum with marked splenomegaly, with suspected focal rupture at the lower portion of the spleen and the extravasation of contrast material indicating active bleeding. Given the patient's hemodynamic stability, he was treated with partial splenic embolization by an interventional radiologist, and transfused with red blood cells. Examination of a bone marrow aspiration and biopsy led to a diagnosis of chronic phase CML. He was discharged from the hospital on day 13 post-embolization. Transcatheter arterial embolization should be considered as the initial treatment of spontaneous splenic rupture, especially in patients with hematological malignancies.

Extramedullary Relapse of Multiple Myeloma Presenting as Mechanical Small Bowel Obstruction: A Case Report / 대한내과학회지

Plasmacytoma in patients with multiple myeloma usually develops in the advanced stage of the disease. We report herein an atypical case of extramedullary relapse of multiple myeloma that presented as mechanical obstruction of the small bowel in a patient who had achieved complete remission after chemotherapy. A 75-year-old man was diagnosed with multiple myeloma 25 months previously and treated with a bortezomib-containing chemotherapy regimen. He presented for evaluation of abdominal pain. A circumferential mass resulting in mechanical ileus was observed by abdominal computed tomography. Biopsy after surgical resection confirmed the diagnosis of plasmacytoma. The patient was subsequently treated with thalidomide-containing chemotherapy, but he died of disease progression after 6 months. We suggest careful observation of unusual relapses of multiple myeloma in patients who have achieved complete remission after antimyeloma therapy.

Outcomes of Vitrectomy for Severe Vitreous Hemorrhage of Unknown Etiology

PURPOSE: To analyze the clinical course and outcomes of vitrectomy for severe vitreous hemorrhage of unknown etiology and to determine the primary cause of hemorrhage during the surgical process. METHODS: The medical records of patients who showed vitreous hemorrhage of Grade IV at their initial visit with no remarkable ophthalmologic or trauma history were reviewed retrospectively. All included patients underwent vitrectomy for severe vitreous hemorrhage for which a primary cause was not revealed before the surgery. The authors investigated the postoperative visual outcome, complications, and etiology of vitreous hemorrhage that was determined during the surgical process. We also analyzed the detailed intraoperative and postoperative funduscopic findings of patients with poor postoperative visual outcomes (BCVA < 20/200). RESULTS: Among the 50 eyes of 50 patients, the causes of vitreous hemorrhage included: branch retinal vein occlusion (48%), central retinal vein occlusion (16%), age-related macular degeneration (12%), retinal tear (8%), diabetic retinopathy (4%), rhegmatogenous retinal detachment (4%), Terson's syndrome (2%), Eales' disease (2%) and unknown causes (4%). The mean best-corrected visual acuity (BCVA) before surgery was 2.17 +/- 0.53 (log MAR) and it was recovered to 0.64 +/- 0.58 (log MAR) 6 months after the surgery (p < 0.001). The branch retinal vein occlusion showed better visual outcome than other disease entities. On funduscopic examination of the patients with poor visual outcome whose postoperative BCVA was poorer than 20/200, macular ischemia, macular degeneration, macular edema, submacular hemorrhage, tractional retinal detachment (including macular), or optic nerve atrophy were verified. CONCLUSIONS: After the vitrectomy for severe vitreous hemorrhage of unknown origin, pathologic findings of macular or irreversible optic nerve atrophy showed poor postoperative BCVA. Of all the causes of vitreous hemorrhage that were revealed after the surgery, branch retinal vein occlusion was the most common etiology of this condition and showed the most favorable visual outcome, comparatively.

Jeju seaweeds suppress lipopolysaccharide-stimulated proinflammatory response in RAW 264.7 murine macrophages

<p><b>OBJECTIVE</b>To investigate the anti-inflammatory effects of Jeju seaweeds on macrophage RAW 264.7 cells under lipopolysaccharide (LPS) stimulation.</p><p><b>METHODS</b>Ethyl acetate fractions were prepared from five different types of Jeju seaweeds, Dictyopteris divaricata (D. divaricata), Dictyopteris prolifera (D. prolifera), Prionitis cornea (P. cornea), Grateloupia lanceolata (G. lanceolata), and Grateloupia filicina (G. filicina). They were screened for inhibitory effects on proinflammatory mediators and cytokines such as nitric oxide (NO), prostaglandin E2, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6).</p><p><b>RESULTS</b>Our results revealed that D. divaricata, D. prolifera, P. cornea, G. lanceolata, and G. filicina potently inhibited LPS-stimulated NO production (IC50 values were 18.0, 38.36, 38.43, 32.81 and 37.14 µg/mL, respectively). Consistent with these findings, D. divaricata, D. prolifera, P. cornea, and G. filicina also reduced the LPS-induced and prostaglandin E2 production in a concentration-dependent manner. Expectedly, they suppressed the expression of inducible NO synthase and cyclooxygenase-2 at the protein level in a dose-dependent manner in the RAW 264.7 cells, as determined by western blotting. In addition, the levels of TNF-α and IL-6, released into the medium, were also reduced by D. divaricata, D. prolifera, P. cornea, G. lanceolata, and G. filicina in a dose-dependent manner (IC50 values for TNF-α were 16.11, 28.21, 84.27, 45.52 and 74.75 µg/mL, respectively; IC50 values for IL-6 were 37.35, 80.08, 103.28, 62.53 and 84.28 µg/mL, respectively). The total phlorotannin content was measured by the Folin-Ciocalteu method and expressed as phloroglucinol equivalents. The content was 92.0 µg/mg for D. divaricata, 151.8 µg/mg for D. prolifera, 57.2 µg/mg for P. cornea, 53.0 µg/mg for G. lanceolata, and 40.2 µg/mg for G. filicina.</p><p><b>CONCLUSIONS</b>Thus, these findings suggest that Jeju seaweed extracts have potential therapeutic applications for inflammatory responses.</p>

Jeju seaweeds suppress lipopolysaccharide-stimulated proinflammatory response in RAW 264.7 murine macrophages

Objective: To investigate the anti-inflammatory effects of Jeju seaweeds on macrophage RAW 264.7 cells under lipopolysaccharide (LPS) stimulation. Methods: Ethyl acetate fractions were prepared from five different types of Jeju seaweeds, Dictyopteris divaricata (D. divaricata), Dictyopteris prolifera (D. prolifera), Prionitis cornea (P. cornea), Grateloupia lanceolata (G. lanceolata), and Grateloupia filicina (G. filicina). They were screened for inhibitory effects on proinflammatory mediators and cytokines such as nitric oxide (NO), prostaglandin E

Considerations of Blood Properties, Outlet Boundary Conditions and Energy Loss Approaches in Computational Fluid Dynamics Modeling / 신경중재치료의학

Despite recent development of computational fluid dynamics (CFD) research, analysis of computational fluid dynamics of cerebral vessels has several limitations. Although blood is a non-Newtonian fluid, velocity and pressure fields were computed under the assumptions of incompressible, laminar, steady-state flows and Newtonian fluid dynamics. The pulsatile nature of blood flow is not properly applied in inlet and outlet boundaries. Therefore, we present these technical limitations and discuss the possible solution by comparing the theoretical and computational studies.

A Case of a Rigid Gas Permeable (RGP) Contact Lens Found as a Foreign Body under the Upper Tarsal Conjunctiva

PURPOSE: To report a case of removing a rigid gas permeable (RGP) contact lens that was found under the upper tarsal conjunctiva after five or more years. CASE SUMMARY: A 60-year-old female patient visited our Department of Ophthalmology due to the irritation of a foreign body sensation in her right eye that had been present for approximately two weeks. The patient started wearing RGP contact lenses 8 years previously. Five years prior, somebody struck her in her right eye, and the patient thought that she lost the RGP lens for her right eye. At that time, she visited the clinic and was diagnosed with corneal erosion, but nothing else in particular. Afterward she continued to visit the clinic 2 to 3 times per year for regular checkup, but nothing notable was found. The best corrected visual acuity and IOP at the initial visit were 0.8 and 27 mm Hg in the right eye and 0.8 and 23 mm Hg in the left eye, respectively. Mild swelling and erythema along the right upper eyelid were identified. As we everted the upper eyelid, a 4 x 4 mm sized, transparent, oval-shaped foreign body with a concave dented center was found. Under the local anesthesia, the foreign body under the upper tarsal conjunctiva was removed and we presumed that the foreign body was the RGP contact lens that had stuck under the conjunctiva due to the incident 5 years prior. After removal, the patient did not express any discomfort and nothing extraordinary was found during the 6 months of follow-up.

Trends in the Incidence of Hospitalized Acute Myocardial Infarction and Stroke in Korea, 2006-2010

This study attempted to calculate and investigate the incidence of hospitalized acute myocardial infarction (AMI) and stroke in Korea. Using the National Health Insurance claim data, we investigated patients whose main diagnostic codes included AMI or stroke during 2006 to 2010. As a result, we found out that the number of AMI hospitalized patients had decreased since 2006 and amounted to 15,893 in 2010; and that the number of those with stroke had decreased since 2006 and amounted to 73,501 in 2010. The age-standardized incidence rate of hospitalized AMI, after adjustment for readmission, was 41.6 cases per 100,000-population in 2006, and had decreased to 29.4 cases in 2010 (for trend P < 0.001). In the case of stroke was estimated at 172.8 cases per 100,000-population in 2006, and had decreased to 135.1 cases in 2010 (for trend P < 0.001). In conclusion, the age-standardized incidence rates of both hospitalized AMI and stroke in Korea had decreased continuously during 2006 to 2010. We consider this decreasing trend due to the active use of pharmaceuticals, early vascular intervention, and the national cardio-cerebrovascular disease care project as the primary and secondary prevention efforts.

Gangrenous Cryoglobulinemic Vasculitis in a Patient with Multiple Myeloma / 대한내과학회지

We report a 62-year-old woman with multiple myeloma associated with cryoglobulinemia accompanied by gangrene of the digits. She presented with generalized purplish net-like discoloration (livedo reticularis), which was more prominent in the lower extremities. Multiple small shallow ulcers with crusts were found in places. In addition, gangrene was observed in both ear helices, both index fingers, and several toes. The patient had monoclonal gammopathy consisting of IgG and kappa (3.95 g/dL), cryoglobulinemia, and bone marrow plasmacytosis (42%). A biopsy of a discolored skin patch on the lower leg revealed leukocytoclastic vasculitis. She was diagnosed with multiple myeloma associated with cryoglobulinemia. Immediate plasmapheresis halted the progression of the skin lesions and digital gangrene. Two cycles of thalidomide plus dexamethasone therapy led to a partial response. This case highlights the need to search for cryoglobulinemia and multiple myeloma when we see livedo reticularis or multiple skin ulcers with obscure causes.