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Type II cryoglobulinemic vasculitis in the setting of MALT lymphoma
  1. Griffin J Reed1,
  2. Antonious Z Hazim2,
  3. Catalina Sanchez-Alvarez3,4 and
  4. Kenneth J Warrington3
  1. 1Internal Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
  2. 2Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Rheumatology, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Catalina Sanchez-Alvarez; catalina.sanchez{at}ufl.edu

Abstract

The objectives of this article are to present a case of type II cryoglobulinemic vasculitis, explain why mucosa-associated lymphoid tissue (MALT) lymphoma is an unusual cause of type II cryoglobulins and to discuss the aetiology, epidemiology, pathophysiology and treatment of cryoglobulinemic vasculitis. A 67-year-old woman presented with 4 months of weight loss, intermittent epistaxis and a purpuric skin rash. Prior to presentation, she was found to have an elevated rheumatoid factor. Further investigation revealed an acute kidney injury and elevated type II cryoglobulins suspicious for cryoglobulinemic vasculitis, which was confirmed by kidney biopsy. Additional workup for the weight loss included biopsy of newly found splenomegaly. Pathology revealed MALT lymphoma, a rare cause of type II cryoglobulinemic vasculitis. Successful medical therapy required treating the underlying malignancy with rituximab and high-dose steroids. After initial resolution of symptoms with this regimen, the patient’s vasculitis worsened, which was thought to be secondary to undertreatment of the lymphoma. Bendamustine was added to further treat the lymphoma, after which the patient recovered and was able to discharge without recurrence of symptoms at 6 months.

  • oncology
  • rheumatology
  • vasculitis

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Footnotes

  • Twitter @catysanchez00, @MdWarrington

  • Contributors CS-A and KJW laid the conceptual framework for the case report. GR wrote the manuscript. AH, CS-A and KJW provided substantial intellectual contributions during revision. All authors reviewed and approved the final 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.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

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