Cold Hard Facts of Cryoglobulinemia

Ghetie, Daniela; Mehraban, Navid; Sibley, Cailin H.

doi:10.1016/j.rdc.2014.09.008

Cited by 28 publications

(20 citation statements)

References 89 publications

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“…The differential diagnosis for small vessel cryoglobulinemic vasculitis includes infection, autoimmune, hypersensitivity, IGA and anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis [2]. In our case, the precipitant of the cryoglobulinemia was initially unclear.…”

Section: Differential Diagnosismentioning

confidence: 74%

“…Most cases of cryoglobulinemic vasculitis are caused by hepatitis C and have only rarely been associated with hepatitis B [1,2]. Precipitation of cryoglobulins may lead to decreased viral load from aggregation of immunoglobulin G (IGG) and immune globulin M (IGM) complexes making cryoglobulinemia within the setting of chronic hepatitis B infection a diagnostic challenge [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Cyroglobulinemia in Chronic Hepatitis B Infection with Undetectable Viral Load

Osman¹,

Honda²,

Ching³

et al. 2017

J Clin Infect Dis Pract

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A 53 year old woman with history of chronic hepatitis B presents with palpable purpura of the lower extremities and recurrent hematuria. She was found to have elevated creatinine (1.4 mg/dl increased from her baseline of 0.8 mg/dl) and proteinuria (6.8 mg/dl). Renal biopsy revealed membranoproliferative glomerulonephritis and epidermal biopsy revealed leukocytoclastic vasculitis. Serum cryoglobulin precipitate was positive and Hepatitis B viral load was initially undetectable as the sample was allowed to cool to room temperature. A repeat sample was retested while keeping the serum above 37°C, this time the viral load was found to be elevated at 361 copies/ml. Both antiviral (entecavir) and immunosuppressive therapy (cyclophosphamide and prednisone) were initiated and the patient's skin and renal manifestations improved rapidly. Proper communication between the clinician and laboratory is essential to ensure an accurate diagnosis in the context of cryoglobulinemic vasculitis.

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Section: Differential Diagnosismentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Cyroglobulinemia in Chronic Hepatitis B Infection with Undetectable Viral Load

Osman¹,

Honda²,

Ching³

et al. 2017

J Clin Infect Dis Pract

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“…MALT lymphoma is a subtype of NHL characterized by B-cell expansion, which may result in increased antibody production. Monoclonal cryoglobulinemia can be the first manifestation of MALT lymphoma, and NHL is estimated to be up to 35 times more likely in patients with cryoglobulinemia [2, 7]. In type I cryoglobulinemia, the overproduction of monoclonal antibodies can damage small vessels and tissues through direct deposition, and can also induce hyperviscosity of the blood [7].…”

Section: Discussionmentioning

confidence: 99%

“…Monoclonal cryoglobulinemia can be the first manifestation of MALT lymphoma, and NHL is estimated to be up to 35 times more likely in patients with cryoglobulinemia [2, 7]. In type I cryoglobulinemia, the overproduction of monoclonal antibodies can damage small vessels and tissues through direct deposition, and can also induce hyperviscosity of the blood [7]. Kidney involvement in MALT lymphoma is unusual, but the most commonly reported glomerular lesion is MPGN most often secondary to light chain monoclonal antibody deposition, although neoplastic disease and thrombotic microangiopathy have also been reported [3, 4].…”

Section: Discussionmentioning

confidence: 99%

Cryoglobulinemic membranoproliferative glomerulonephritis associated with mucosaassociated lymphoid tissue lymphoma treated with rituximab

Ha¹,

Noronha²,

Gleason³

et al. 2016

CNCS

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Cryoglobulinemia and mucosa-associated lymphoid tissue (MALT) lymphoma are diseases characterized by B-cell dysregulation and overproduction of antibodies. Vasculitis and cutaneous manifestations are common, but renal involvement is rare. A 65-year-old woman with type 1 cryoglobulinemia and MALT lymphomas of the right lacrimal and parotid glands successfully treated by excision and chemoradiotherapy, presented with dyspnea on exertion, edema, and hematuria. Renal biopsy findings revealed type 1 cryoglobulinemic glomerulonephritis. She underwent treatment with high-dose oral prednisone and intravenous rituximab with subsequent return of creatinine to baseline levels. To our knowledge, this is the first report of a patient in whom type 1 cryoglobulinemia, multiple MALT lymphomas, and MPGN with IgM cryoglobulin deposits coexist. Evidence for rituximab is sparse with widely varying protocols and mixed results. There is a need for high quality evidence in the treatment of these conditions.

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“…Immunoglobulin precipitates at temperatures below 4ºC and dissolves at 37ºC, corresponding to cryoglobulinemias. 22 , 23 Cryofibrinogenemias are caused by plasma fibrinogens that gel at low temperatures, and cold agglutinin antibodies promote erythrocyte agglutination at cold temperatures, causing vascular occlusion. 11…”

Section: Introductionmentioning

confidence: 99%

Pigmented purpura and cutaneous vascular occlusion syndromes

Lamadrid-Zertuche

Garza‐Rodríguez

Candiani

2018

An. Bras. Dermatol.

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Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes.

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Cold Hard Facts of Cryoglobulinemia

Cited by 28 publications

References 89 publications

Cyroglobulinemia in Chronic Hepatitis B Infection with Undetectable Viral Load

Cyroglobulinemia in Chronic Hepatitis B Infection with Undetectable Viral Load

Cryoglobulinemic membranoproliferative glomerulonephritis associated with mucosaassociated lymphoid tissue lymphoma treated with rituximab

Pigmented purpura and cutaneous vascular occlusion syndromes

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