Essential mixed cryoglobulinemia type II: case report
DOI:
https://doi.org/10.31053/1853.0605.v74.n3.17550Keywords:
mixed cryoglobulinemia, cryoglobulinaemic vasculitis, glomerulonephritisAbstract
The cryoglobulinemic syndrome is produced by precipitating immunoglobulins at low temperatures. Its production is associated with several causes, such as lymphoproliferative disorders, chronic infections and autoimmune disorders. However, the etiology is unknow. There are three types of cryoglobulins. Type II and III are the mixed. Type III produce a systemic vasculitis with diverse clinical manifestations. Palpable purpura is the most common, accompanied by arthralgia, neuropathy and type I membranoproliferative glomerulonephritis. We present a case of a 71 years old male patient with renal failure, nephritic syndrome, arterial hypertension and palpable purpuric skin lesions in members, thorax and abdomen. During hospitalization essential mixed cryoglobulinemia associated with cutaneous leukocytoclastic vasculitis and type I membranoproliferative glomerulonephritis was diagnosed. Complementary methods, treatment instituted and the patient's clinical course are described.Downloads
References
-Brouet JC, Clouvel JP, Danon F, Klein M, Seligmann M. Biologic and clinical significance of cryoglobulins. Am J Med 1974,57:775-88
-Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL, et al. Nomenclature of systemic vasculitides: the proposal of an international consensus conference. Arthritis Rheum 1994;37:187-92
-Landau DA, Scerra S, Sene D, Resche-Rigon M, Saadoun D, Cacoub P. Causes and predictive factors of mortality in a cohort of patients with hepatitis C virus-related cryoglobulinemic vasculitis treated with antiviral therapy. J Rheumatol. 2010;37:615-21
-Mazzaro C, Tulissi P, Moretti M, Mazzoran L, Pussini E, Crovatto M, et al. Clinical and virological findings in mixed cryoglobulinaemia. J Intern Med 1995;238:153-60
-Monti G, Galli M, Invernizzi F, Pioltelli P, Saccardo F, Monteverde A, et al. Cryoglobulinemia: a multi-centre study of the early clinical and laboratory manifestations of primary and secondary disease. Q J Med 1995;88:115-26
-Ramos-Casals M, Font J. Mixed cryoglobulinemia. Essential?. Med Clin (Barc) 1999;113:577-8
-Frankel AH, Singer DR, Winearls CG, Evans DJ, Rees AJ, Pusey CD. Type II essential mixed cryoglobulinemia: Presentation, treatment and outcome in 13 patients. Q J Med 1992;82:101-24
-Ferri MC, Zignego AL, Pileri SA. Cryoglobulins (review). J Clin Pathol 2002;55:4-13
-Ferri C, Sebastiani M, Giuggioli D, Cazzato M, Longombardo G, Antonelli A, et al. Mixed Crioglobulinemia: demographic, clinical, and serological features, and survival in 231 patients. Sem Arthritis Rheum 2004;33:355-74
-Damoiseaux J. The diagnosis and classification of the cryoglobulinemic syndrome (review). Autoimmunity Reviews 2014;13:359-62
-Lamprecht P, Gause A, Gross WL. Cryoglobulinemic vasculitis (review). Arthritis Rheum 1999;42:2507-16
-Ferri C, Antonelli A, Mascia MT, Sebastiani S, Fallhai P, Ferrari D, et al. B-cells and mixed cryoglobulinemia. Autoimmun Rev 2007;7:114-20
-Retamozo S, Brito-Zerón P, Bosch X, Stone JH, Ramos-Casals M. Cryoglobulinemic disease. Oncology (Williston Park). 2013 Nov;27(11):1098-1105
-AntonelliA, FallahiP, Ferrari SM, CorradoA, Sebastian M, GiuggioliD, et al. Parallel increase of circulating CXCL11 and CXCL10 in mixed cryoglobulinemia, while the proinflammatory cytokine IL-6 is associated with high serum Th2 chemokine CCL2. Clin Rheumatol. 2013;32:1147-54
-Sabbatini A, Dolcher MP, Marchini B, Chimenti D, Moscato S, Pratesi F, et al. Clin Exp Rheumatol 1997;15:655-8
-Meltzer M, Franklin EC, Elias K, McCluskey RT, Cooper N. Cryoglobulinemia: A clinical and laboratory study. II. Cryoglobulins with rheumatoid factor activity. Am J Med 1966;40:837-56
-Tedeschi A, Baraté C, Minola E, Morra E. Cryoglobulinemia. Blood Reviews 2007;21:183-200
-D’Amico G. Renal involvement in hepatitis C infection: cryoglobulinemic glomerulonephritis induced byhepatitis C virus. Kidney Int 1998;54:650-71
-Hirahashi J, Kuramochi S, Konishi K, Chikaraishi A, Takase O, Hayashi M, et al. Glomerulonephritis with microtubular deposits associated with cryoglobulinemia and chronic active hepatitis. Pathol Int. 2002 Jul;52(7):483-7
-Tarantino A, De Vecchi A, Montagnino G, Imbasciati E, Mihatsch MJ, Zollinger HU, et al. Renal disease in essential mixed cryoglobulinemia: Long-term follow-up of 44 patients. Q J Med 1981;50:1-30
-Cordonnier D, Martin H, Groslambert P, Micouin C, Chenais F, Stoebner P. Mixed IgG-IgM cryoglobulinemia with glomerulonephritis: Immunochemical, fluorescent and ultrastructural study of kidney and in vitro cryoprecipitate. Am J Med 1975;59:867-72
-D'Amico G, Colasanti G, Ferrario F, Sinico RA. Renal involvement in essential mixed cryoglobulinemia. Kidney Int 1989;35:1004-14
-Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science 1989;244:359-62
-Pascual M, Perrin L, Giostra E, Schifferli J. Hepatitis C virus in patients with cryoglobulinemia type II [letter]. J Infect Dis 1990;162:569-70
-Misiani R, Bellavita P, Fenili D, Borelli G, Marchesi D, Massazza M, et al. Hepatitis C virus infection in patients with essential mixed cryoglobulinemia. Ann Intern Med 1992;117:573-7
-Galli M. Viruses and cryoglobulinemia. Clin Exp Rheumatol 1995;13:63-70
-Agnello V, Chung RT, Kaplan LM. A role for hepatitis C virus infection in type II cryoglobulinemia. N Engl J Med 1992;327:1490-5
-Levo Y, Gorevic PD, Kassab HJ, Zucker-Franklin D, Franklin EC. Association between hepatitis B virus and essential mixed cryoglobulinemia. N Engl J Med 1977;296:1501-4
-Cacoub P, Terrier B. Hepatitis B-related autoimmune manifestations. Rheum Dis Clin North Am 2009;35:125-37
-Fornasieri A, Armelloni S, Bernasconi P, Li M, Septis C, Sinico R, et al. High binding of IgMk rheumatoid factor from type II cryoglobulins to cellular fibronectin. Am J Kidney Dis 1996;27:476-83
-Ben-Bassat M, Boner G, Rosenfeld J, Pick AI, Kahana M, Hazaz B, et al. The clinicopathologic features of cryoglobulinemic nephropathy. Am J Clin Pathol 1983;79:147-56
-Valbonesi M, Montani F, Mosconi L, Florio G, Vecchi C. Plasmapheresis and cytotoxic drugs for mixed cryoglobulinemia. Haematologia (Budap) 1984;17:341-51
-Poynard T, Bedossa P, Chevallier M, Mathurin P, Lemonnier C, Trepo C, et al. A comparison of three interferon alfa-2β regimens for the long-term treatment of chronic non-A, non-B hepatitis. N Engl J Med 1995;332:1457-62
-Cobelo C, Sola E, López V, Gutiérrez de la Fuente C, Hernández Marrero D. Crioglobulinemia mixta en una paciente sometida a transplante renal. Nefrología 2010; 30:480-1
-Martina MN, Solé M, Massó E, Pérez N, Campistol JM, Quintana LF. Mixed cryoglobulinaemia not related to hepatitis C virus, mesangiocapillary glomerulonephritis and lymphoplasmocytic lymphoma. Nefrologia 2011;31:743-6
Zaja F, De Vita S, Mazzaro C, Sacco S, Damiani D, De Marchi G, et al. Efficacy and safety of rituximab in type II mixed cryoglobulinemia. Blood 2003;101:3827-34
Hiesse C, Bastuji-Garin S, Santelli G, Moulin B, Cantarovich M, Lantz O, et al. Recurrent essential mixed cryoglobulinemia in renal allografts. Report of two cases and review of the literature. Am J Nephrol 1989;9:150-4
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