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Case Reports: Unusual presentation of more common disease/injury
Case of cryoglobulinaemia associated with chronic hepatitis B
  1. Himabindu Kolli1,
  2. Mukarram Jamat Ali2,
  3. Karen J Campoverde Reyes2 and
  4. Daryl T-Y Lau2
  1. 1Department of Medicine, The University of Texas Rio Grande Valley School of Medicine, Weslaco, Texas, USA
  2. 2Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Daryl T-Y Lau; dlau{at}bidmc.harvard.edu

Abstract

We present a case of a woman in her 50s with chronic hepatitis B (CHB) who had a longstanding history of arthralgia and swollen joints associated with severe fatigue. Investigations were consistent with a diagnosis of hepatitis B virus (HBV)-related cryoglobulinaemia. Two months after treatment with tenofovir alafenamide, an antiviral therapy for HBV, there was a significant improvement of her symptoms and undetectable serum cryoglobulins. Cryoglobulinaemia is a relatively rare extrahepatic manifestation of HBV infection and only presents in about 2%–4% of the patients with CHB. Its clinical manifestations include purpura, renal dysfunction, arthralgias and neuropathy. Since the presentation of cryoglobulinaemia in CHB can be non-specific, one needs to have a high index of suspicion to avoid delay in diagnosis and treatment.

  • Hepatitis B
  • Vasculitis
  • Immunology

https://doi.org/10.1136/bcr-2022-249630

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    Footnotes

    • Contributors DT-YL provided the concept and direction of writing the case report, the learning points and editing of the final manuscript; HK and KJCR reviewed the literature and wrote the first draft of the manuscript. MJA and HK contributed to the addition of literature, revision and edition of 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.

    • 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.