A 77-year-old male consulted for edema, skin changes, asthenia, anorexia, weight loss and leg corkiness of more than one year of evolution. About two years earlier, primary hypothyroidism was detected and levothyroxine was started. Progressively, hyperpigmentation on the trunk, erythema with acrocyanosis on both hands (left panel), pitting edema (right panel), numbness and weakness in the legs appeared. Blood tests showed thrombocytosis, elevated inflammatory markers and a monoclonal IgA lambda band of 1064 mg/dL, although without anemia and with normal glomerular filtration rate and calcemia.
