Vasculitic emergencies in the intensive care unit: a special focus on cryoglobulinemic vasculitis

Abstract

Vasculitis is characterized by the infiltration of vessel walls by inflammatory leukocytes with reactive damage and subsequent loss of vessel integrity. The clinical course of systemic vasculitis may be punctuated by acute life-threatening manifestations that require intensive care unit (ICU) admission. Furthermore, the diagnosis may be established in the ICU after admission for a severe inaugural symptom, mostly acute respiratory failure. Among the systemic vasculitides, cryoglobulinemic vasculitis (CV) has been rarely studied in an ICU setting. Severe CV-related complications may involve the kidneys, lungs, heart, gut, and/or central nervous system. The diagnosis of CV in the ICU may be delayed or completely unrecognized. A high level of suspicion is critical to obtain a timely and accurate diagnosis and to initiate appropriate treatment. We describe severe acute manifestations of CV based on six selected patients admitted to our ICU. That all six patients survived suggests the benefit of prompt ICU admission of patients with severe CV.

Impact of mixed cryoglobulinemia on patients with spontaneous hepatitis C virus clearance: A 13‐year prospective cohort study

“…However, none of the patients yielded MCS implies that HCV RNA might be crucial in the pathogenesis of MC‐associated vasculitis and eradication of HCV infection is indeed the effective treatment for most MCS patients . In addition, all the differences including gender bias, cirrhosis rate, and IgG, IgM, FIB‐4 and C4 levels observed between the MC (+) and MC (−) patients have been consistently reported in the CHC studies . It did not only strengthen the reliability of our results, but also indicate the core manifestations of HCV‐associated MC, regardless of the presence of the virus.…”

HCV related severe cryoglobulinemic vasculitis treated with plasma exchange and rituximab: case report and literature review

“…Cryo-GN appears in more than 20% of cases and it usually presents itself with mild proteinuria, microscopic hematuria and hypertension. In 70%-80% of those cases renal biopsy reveals type 1 membranoproliferative GN [11]. Our patient was uncooperative for kidney biopsy and therefore Cryo-GN was diagnosed in accordance with the previously defined clinical criteria [12,13].…”

“…Retamozo et al reviewed a total of 279 cases with life-threatening CryoVas (30 from their department) and found that in 232 patients (83%) it was the first manifestation of cryoglobilinemia [10]. They suggested awareness of life-threatening CryoVasas a differential diagnosis in ICU [11].…”

Renal disease presenting as acute kidney injury

“…Indeed, renal involvement is the most common cryoglobulinaemic vasculitis related visceral manifestation with AKI seen in more than 30% of cases. Presenting as a multisystem disorder is not uncommon and although ICU experience is scant results from one centre suggest early ICU referral may translate into an excellent initial outcome [29].…”