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Case Report Open Access

A rare dermatological manifestation of follicular spicules in a patient with multiple myeloma and end‑stage renal disease on hemodialysis: A case report

  • Authors:
    • Xiaobing Li
    • Xuemei Li
    • Qin Li
    • Qian Li
    • Yongsheng Liu
    • Li Zhang
    • Li Wang
  • View Affiliations / Copyright

    Affiliations: Science and Technology Industry Development Center, Chongqing Medical and Pharmaceutical College, Chongqing 401331, P.R. China, Department of Neurology, NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China, Department of Ideological and Political Theory Studies, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing 400060, P.R. China
    Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 180
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    Published online on: July 23, 2025
       https://doi.org/10.3892/etm.2025.12930
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Abstract

Multiple myeloma (MM) is a hematological malignancy characterized by the clonal expansion of malignant plasma cells within the bone marrow, leading to diverse systemic complications. While cutaneous manifestations of MM are uncommon, follicular spicules represent a highly specific but rare dermatological finding associated with MM. The present study presents the case of a 59‑year‑old man with MM who exhibited follicular acanthosis and hyperkeratosis as cutaneous indicators of the malignancy. The patient, with a history of stage 5 chronic kidney disease undergoing maintenance hemodialysis, was diagnosed with follicular spicules of MM (FSMM) through clinical evaluation and laboratory investigations. The present case highlights the clinical importance of recognizing rare cutaneous manifestations in MM, which can serve as critical diagnostic clues. Improved awareness of FSMM may facilitate a timely diagnosis and optimize patient management, ultimately contributing to improved clinical outcomes in this challenging population.
View Figures

Figure 1

Karyotype analysis revealing complex
chromosomal abnormalities in advanced MM. Conventional karyotyping
revealed multiple numerical and structural abnormalities (red
arrows) characteristic of high-risk MM: i) Hyperdiploidy with
tetraploid cells (83-85<4n>,XXY), including an additional X
chromosome. ii) Loss of Y chromosome (-Y), a common finding in
hematological malignancies. iii) High-level polysomy of chromosome
1 (+1,+1), totaling four copies, indicating aggressive disease. iv)
Dicentric chromosome [dic(1;10)(p13;q26)], suggesting genomic
instability. v) Pseudo-isodicentric chromosome [psu idic(1)(p21)], reflecting complex chromosomal
rearrangement. vi) Additional material on chromosomes 7 and 8
[add(7)(q32),add(8)(p23)x2]. vii) Possible unidentified
material on chromosome 17 [?add(17)(q22)x2]. ix) Monosomy of chromosomes
19, 20, 21 and 22 (green arrows). xi) One to two marker chromosomes
(+1-2mar). xii) Mosaic karyotype: Four abnormal clones with complex
karyotype and 16 normal male karyotypes (46,XY), consistent with
clonal evolution. MM, multiple myeloma.

Figure 2

SPE and immunofixation confirming
monoclonal gammopathy. (A) SPE demonstrating an M-spike in the γ
region. (B) Immunofixation electrophoresis revealing a monoclonal
IgA λ pattern, confirming the presence of IgA-λ type multiple
myeloma. (C) Immunofixation electrophoresis further confirming the
monoclonal IgA λ pattern. AU, arbitrary units; SPE, serum protein
electrophoresis. ELP, electrophoresis reference; G, IgG; A, IgA; M,
IgM; K, κ light chain; L, λ light chain; D, IgD; E, IgE.

Figure 3

Immunohistochemical characterization
of bone marrow biopsy. (A) Congo red staining showed amyloid
deposits with birefringence under polarized light, confirming
amyloidosis. (B) Scattered CD3+ T cells. (C)
CD20+ B cells. (D) Diffuse CD56 positivity indicating
natural killer cell involvement. (E) Diffuse CD138 staining marking
plasma cell infiltration. (F) Negative κ light chain staining. (G)
Diffuse positive staining of λ light chains, confirming
monoclonality. (H) Multiple myeloma oncogene 1-positivity indicated
plasma cell differentiation. (I) Hematoxylin and eosin staining
revealed diffuse infiltration by atypical lymphoid/plasma cells.
(J) Positive staining for amyloid deposits in bone marrow biopsy.
All images were captured under a light microscope at x400
magnification.

Figure 4

Flow cytometric immunophenotyping of
bone marrow cells from a patient with PCM. (A) Lymphocyte analysis
showing a decreased CD4/CD8 ratio. (B and C) Quantification of
CD57⁺ LGLs, demonstrating a normal proportion of this subset. (D)
Marked expansion of plasma cells detected within the bone marrow
aspirate. (E) Dual-parameter plot of CD38 and CD45 expression
revealing a distinct CD38bright+/CD45dim+
population, accounting for 33.19% of total nucleated cells,
consistent with malignant plasma cell infiltration. (F)
Intracellular immunoglobulin light chain staining within the
CD38bright+ population indicating prominent λ light
chain restriction (97.37%) with minimal κ expression (0.03%),
confirming clonal proliferation and supporting the diagnosis of
PCM. LGLs, large granular lymphocytes; NC, nucleated cell; PCM,
plasma cell myeloma; A, allophycocyanin-Alexa Fluor 700; APC,
allophycocyanin; CD38bri+, CD38 bright positive; DNT,
double negative T cells; DPT, dual-parameter plot; ECD,
energy-coupled dye; H, height parameter; KO525, Krome Orange 525;
Lym, lymphocytes; NK, natural killer cells; PC5.5,
phycoerythrin-cyanine 5.5; PE, phycoerythrin; SSC, side
scatter.

Figure 5

Comprehensive imaging and
histopathological evaluation. (A) An anterior scout image from CT
demonstrated diffuse skeletal involvement, including multiple
hypodense lesions in the skull, ribs, spine, scapulae and pelvis,
consistent with lytic lesions seen in multiple myeloma. Bilateral
pulmonary infections and pleural thickening were also visible. (B)
A lateral scout image further illustrated spinal abnormalities,
including compression of the T12 vertebral body and suspected
Hsu-Mo nodule at T1, as well as degenerative spinal changes. (C) An
axial pelvic CT revealed lytic bone lesions, bilateral pathological
rib fractures and pelvic effusion. (D) Histopathological
examination of a skin lesion showed squamous epithelium with marked
hyperkeratosis (hematoxylin and eosin staining; original
magnification, x100), supporting dermatopathological
involvement.

Figure 6

Clinical progression of cutaneous
manifestations and therapeutic response. (A) Pre-treatment image of
the face showing widespread scaling and crusted lesions. (B)
Post-treatment image of the same area with notable resolution of
lesions following systemic corticosteroid therapy. (C) Chest
lesions showing follicular keratotic papules and erythematous
pinpoint eruptions, consistent with follicular spicules of multiple
myeloma.

Figure 7

Timeline of clinical course and
interventions in a patient with IgA-λ type MM. The patient was
diagnosed with stage III MM (subtype B, IgA-λ type) and regular
hemodialysis was initiated. In March 2024, follicular acanthosis
was noted; treatment included levothyroxine, esomeprazole,
urotropine, urea cream, nadifloxacin cream and blood transfusion.
In April 2024, the patient developed type II expiratory failure and
was admitted to the ICU for CRRT, non-invasive ventilator support,
and symptomatic management. Despite intensive care, the patient
succumbed to disease-related complications. CRRT, continuous renal
replacement therapy; ICU, Intensive Care Unit; MM, multiple
myeloma.
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Copy and paste a formatted citation
Spandidos Publications style
Li X, Li X, Li Q, Li Q, Liu Y, Zhang L and Wang L: A rare dermatological manifestation of follicular spicules in a patient with multiple myeloma and end‑stage renal disease on hemodialysis: A case report. Exp Ther Med 30: 180, 2025.
APA
Li, X., Li, X., Li, Q., Li, Q., Liu, Y., Zhang, L., & Wang, L. (2025). A rare dermatological manifestation of follicular spicules in a patient with multiple myeloma and end‑stage renal disease on hemodialysis: A case report. Experimental and Therapeutic Medicine, 30, 180. https://doi.org/10.3892/etm.2025.12930
MLA
Li, X., Li, X., Li, Q., Li, Q., Liu, Y., Zhang, L., Wang, L."A rare dermatological manifestation of follicular spicules in a patient with multiple myeloma and end‑stage renal disease on hemodialysis: A case report". Experimental and Therapeutic Medicine 30.3 (2025): 180.
Chicago
Li, X., Li, X., Li, Q., Li, Q., Liu, Y., Zhang, L., Wang, L."A rare dermatological manifestation of follicular spicules in a patient with multiple myeloma and end‑stage renal disease on hemodialysis: A case report". Experimental and Therapeutic Medicine 30, no. 3 (2025): 180. https://doi.org/10.3892/etm.2025.12930
Copy and paste a formatted citation
x
Spandidos Publications style
Li X, Li X, Li Q, Li Q, Liu Y, Zhang L and Wang L: A rare dermatological manifestation of follicular spicules in a patient with multiple myeloma and end‑stage renal disease on hemodialysis: A case report. Exp Ther Med 30: 180, 2025.
APA
Li, X., Li, X., Li, Q., Li, Q., Liu, Y., Zhang, L., & Wang, L. (2025). A rare dermatological manifestation of follicular spicules in a patient with multiple myeloma and end‑stage renal disease on hemodialysis: A case report. Experimental and Therapeutic Medicine, 30, 180. https://doi.org/10.3892/etm.2025.12930
MLA
Li, X., Li, X., Li, Q., Li, Q., Liu, Y., Zhang, L., Wang, L."A rare dermatological manifestation of follicular spicules in a patient with multiple myeloma and end‑stage renal disease on hemodialysis: A case report". Experimental and Therapeutic Medicine 30.3 (2025): 180.
Chicago
Li, X., Li, X., Li, Q., Li, Q., Liu, Y., Zhang, L., Wang, L."A rare dermatological manifestation of follicular spicules in a patient with multiple myeloma and end‑stage renal disease on hemodialysis: A case report". Experimental and Therapeutic Medicine 30, no. 3 (2025): 180. https://doi.org/10.3892/etm.2025.12930
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