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Case Reports: Rare disease
Mixed cryoglobulinaemic vasculitis with pulmonary infiltrates and cavitation
  1. Adrian Mark Masnammany,
  2. Peter Kee Kee Wong,
  3. Beverly Cheok Kuan Ng and
  4. Nicholas Manolios
  1. Rheumatology, Westmead Hospital, Westmead, New South Wales, Australia
  1. Correspondence to Dr Adrian Mark Masnammany; adrianmark876{at}gmail.com

Abstract

Cryoglobulinaemic vasculitis is an immune complex-mediated vasculitis with a myriad of clinical manifestations. We report a rare case of a patient in her 60s with rheumatoid arthritis who presented with fever of unknown origin, cutaneous leucocytoclastic vasculitis and progressive pulmonary infiltrates with cavitation. Extensive investigation for an infectious aetiology was unrevealing. Blood investigations revealed high-titre rheumatoid factor, hypocomplementaemia, raised inflammatory markers and the presence of type 2 cryoglobulins. A diagnosis of cryoglobulinaemic vasculitis with pulmonary involvement was made, and the patient was treated with high-dose prednisolone and rituximab, which resulted in complete resolution of lung changes and marked clinical improvement. This case highlights the rarity of lung involvement, including cavitation in cryoglobulinaemic vasculitis.

  • Vasculitis
  • Rheumatoid arthritis
  • Connective tissue disease
  • Rheumatology
  • Respiratory medicine

https://doi.org/10.1136/bcr-2022-251705

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    Footnotes

    • Contributors AM was the lead author involved in the design, drafting of the manuscript and patient management. PW and BN were the consultants leading the clinical management of the patient, as well editing the manuscript. NM was involved in the design and editing of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.