A 67-year-old man with chronic lymphocytic leukemia (CLL) presented with a painful rash. On physical examination, there was purple discoloration of the ear along with livedoid skin changes on the cheek and purpura on both calves. A skin biopsy showed leukocytoclastic vasculitis. Laboratory testing was notable for a low complement 4 level. What is the most likely diagnosis?
一名67岁男性慢性淋巴细胞白血病(CLL)患者因皮疹疼痛就诊。体检:耳部紫染，面颊皮肤青斑样改变，双小腿紫癜。皮肤活检显示白细胞碎裂性血管炎。值得注意的是，患者的补体4水平低。最有可能的诊断是什么?
A. Behçet’s disease Behçet的疾病
B. Cryoglobulinemic vasculitis 冷球蛋白血症性血管炎
C. Granulomatosis with polyangiitis 肉芽肿性多血管炎
D. Leukemia cutis 皮肤白血病
E. Microscopic polyangiitis 显微镜下多血管炎
答案解析：
患者自诉在暴露于≤3℃的温度时出现皮疹。值得注意的是，实验室检测结果显示，IgG λ的冷冻压积水平为4%。诊断为继发于CLL的ⅰ型冷球蛋白血症性血管炎。经过6周的全身化疗和利妥昔单抗治疗后，患者症状减轻。
正确答案：B
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