HEMATOLOGY, ONCOLOGY, ALLERGY,AND IMMUNOLOGYIchthyosis
■ Diffuse, dry scaling lesions
■ Associated with lymphoma, breast, cervical, lung, and colon CAs
Pruritus
■ Itching and burning sensation of the skin
■ Associated with Hodgkin disease, leukemia, multiple myeloma, poly-
cythemia vera, adenocarcinoma, carcinoid syndrome
Sister Mary Joseph Node
■ Periumbilical nodule
■ Associated with advanced adenocarcinoma (gastric, ovarian)
Urticaria
■ Transient areas of raised, red wheals
■ Associated with Hodgkin disease, leukemia, internal carcinoma, multiple
myeloma
Purpura
■ Red or purple discoloration of the skin
■ Associated with Hodgkin disease, acute leukemias, lymphoma, multiple
myeloma, polycythemia vera
MULTIPLE MYELOMAMalignant plasma cell disorder accompanied by urine/serum paraprotein
SYMPTOMS/EXAM
■ Hypercalcemia, anemia, lytic bone lesions, acute renal failure
DIAGNOSIS
■ Bone survey, serum/urine protein electrophoresis
TREATMENT
■ Oral alkylating agent, steroids, local radiation for bony lesions
HYPERSENSITIVITY REACTIONSThere are four classes of immune-mediated (hypersensitivity) reactions (see
Table 9.12).
A 40-year-old male with an allergy to peanuts presents with hives and hypo-
tension after a peanut exposure. The patient has a history of hypertension for
which he takes atenolol. The patient’s BP remains low after two doses of IM
epinephrine and a 2-L NS bolus. What is the most appropriate next therapy?
Glucagon (1 mg every 5 minutes) is indicated in the treatment of anaphylaxis
with refractory hypotension in patients on β-blockers.