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Dr. Andrew Rynne

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What causes purpura and swelling at the base of thumb and across wrist?

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Dr. Monish De

Oncologist

Practicing since :2004

Answered : 1645 Questions

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Posted on Sat, 23 Aug 2014 in Blood Disorders
Question: I am having a problem with unsightly purpura and swelling (some achiness) at the base of my left thumb and across my wrist for the past approximately 1 1/2 years now. The veins on the top of this hand also appear much larger and protruding than my other hand. The purpura remains for a few months and when it is almost faded I will wake up in the morning and it is back again! I have a history of CAD and also heart attacks and am on Plavix and low dose asa for about 15 years now but the purpura started only 1 1/2 years ago. I first asked my cardiologist about it last year but he said it was from the medications and not to worry about it (but the kind of purpura he is referring to appears here there and everywhere, not the exact same place repeatedly just like old age purpura does). I am seeing an oncologist every 3 months (for blood tests) for the past year or so because I have an elevated IGM (in the bone marrow also). She is supposedly and oncologist/hemotologist and told me that this will most likely turn into Waldenstroms in the next decade if not sooner. I asked her about the purpura because I have read there is something called Waldenstrom purpura that always appears in the same location. She confirmed this but said it is puzzleing because My IGM is not elevated enough to be Waldenstroms yet. I have also seen a orthopedic hand surgeon that says there are no broken bones in the wrist or arthritis and a referal to a rheumatologist showed no arthritis during blood testing. This is a VERY frustrating situation. Do you have any idea what it could be or what type of specialist I should be seeing? I can give you any lab result information you may want.
doctor
Answered by Dr. Monish De 8 hours later
Brief Answer:
hypergammaglobulinemic purpura of Waldenström

Detailed Answer:
Hi

Since you are having purpura and swelling at the base of your left thumb and across your wrist for the past approximately 1 1/2 years and an elevated IGM you may be progressing towards hypergammaglobulinemic purpura of Waldenström.

It occurs most commonly in women. It may be a primary syndrome or associated with other disorders, such as Sjögren syndrome, hepatitis C virus, rheumatoid arthritis, Raynaud phenomenon and multiple myeloma.

The exact pathogenesis of the development of purpura in this disease is not clear , however excessive production of polyclonal immunoglobulins may be responsible.

The disease generally is benign but chronic.Generally, no specific treatment is needed, but get in touch with your hematologist to conduct tests to rule out an underlying connective tissue disease.

Treatment with colchicine with or with out steroids or hydroxychloroquine sulfate showed have showed marked response.Compression stockings can also be used for this condition.Get in touch with your hematologist regarding discussing these treatment options.

Hope i have answered your query

Regards
DR De









Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Monish De 10 hours later
I sent you a reply and question but I cannot tell uif it went through. Please advise
doctor
Answered by Dr. Monish De 8 minutes later
Brief Answer:
Not received reply

Detailed Answer:
Hi

I have not received your reply and question yet.

Regards
DR De
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Monish De 1 hour later
I think you might need these lab results to answer my question:

My IGA & IGG are always within normal range. My IGM has been elevated & fluctuating between 418 & 665 since Oct 2012 with this months being 581. Free Kappa also elevated fluctuating between 20.5 & 23.3 with this months being 20.8. Free Lambda 26.4 to 29.0 with this months beibng 29.0. Free Kappa/Lambda ration has always been within range since Oct 2012, 0.72-0.85 with this months being 0.72. Serum Immunofixation in May of 2013 showed a faint IGM (lambda) monoclonal immunoglobulin but all above results were on a polyclonal backround. Bone marrow biopsy in May of 2013 showed a 3% plasma cell increase with increased lambda production. All other bloodwork pretty much in normal ranges and my rheumatoid factor is within normal range. I did loose a kidney about 2 yrs ago but nobody knows why (it was attributed to "an unknown metabolic occurence". My GFR fluctuates between 58 & 60 which the nephrologist says is fine for my age and there is no protien in my urine. I have CAD (familial) and in the past 15 yrs have had 6 heart attacks, a number of angioplasties and a stent. I am doing fine on Plavix, asa, crestor, losartan & toprol and have not had another heart attack in over 3 years. I am a perfect weight 5'2" and 110 lbs, eat a very healthy cardiac/renal diet, exercise daily and people think I'm crazy when they hear about all of these medical problems I have. I look and feel perfectly healthy.

All of the articles I have found say hypergammaglobulinemic purpura of Waldenström affects the lower limbs. My legs are fine (not even any edema), it's just my left wrist and arm. This has me totally baffled. In your opinion do these numbers really mean I will DEFINATELY get Waldenstroms in the next 6 years or so like I was told? I know anything is possible but WM is pretty rare. Is it because of the immunofixation that makes it definate for WM ay some point in time?
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Follow up: Dr. Monish De 2 minutes later
OOOPS, those numbers are all mg no G. Sorry about that
doctor
Answered by Dr. Monish De 48 minutes later
Brief Answer:
Hirudoid cream

Detailed Answer:
Hi

As there is no purpura in your lower limbs the swelling at the base of your left thumb and across your wrist could be due to the medication plavix which you are using for your coronary artery disease.

Sometimes long time use of this medication which contains clopidogrel and is used to prevent blood clots can cause purpura and swelling in the skin in the base of the thumb.

I suggest u apply Hirudoid cream locally at the base of your left thumb.
The cream contains heparinoid which acts by improving circulation by dissolving small blood clots and improving blood supply and swelling of skin thereby reducing purpura.

Regards
DR De



Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Monish De 7 hours later
Thanks for the info on Hirudoid cream. Unfortunately I cannot get it our here in the US but do have a compounding pharmacy close by that will probably work with me. I do have one concern though since this cream is 3% heparinoid. Is there any risk factor since I am taking plavix 50mg and 81mg asa daily? I asked some pharmacists today but they could not advise me because they have never even heard of Hirudoid cream.
doctor
Answered by Dr. Monish De 3 hours later
Brief Answer:
no risk factor

Detailed Answer:
Hi

There is no risk factor in case of use of the hirudoid cream.
This medicine is not known to affect other medicines.

You can safely gently massage about 5 to 15 mg of cream to the affected area. If the area is tender to touch, the cream can be applied around the area, rather than directly on to the area. This can be repeated up to four times a day.

Wishing you good health.

If you have no more clarifications then please rate the answer and close the thread.

Regards
Dr De

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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