RT Journal Article
SR Electronic
T1 Mixed cryoglobulinemia: a diagnostic and therapeutic challenge
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2017-219768
DO 10.1136/bcr-2017-219768
VO 2017
A1 Maria Túlio
A1 Liliana Carvalho
A1 Tiago Bana e Costa
A1 Cristina Chagas
YR 2017
UL http://casereports.bmj.com/content/2017/bcr-2017-219768.abstract
AB Mixed cryoglobulinemia is frequently secondary to hepatitis C virus infection. Diagnosis and therapeutic management are challenging, depending on the spectrum and severity of manifestations, as well as on the presence of comorbidities. We describe a case of a 79-year-old woman with a non-cirrhotic hepatitis C virus infection presenting with weakness, arthralgias, purpuric rash with left leg ulcerative lesions, bilateral peripheral sensorimotor polyneuropathy, renal impairment and cardiac failure. The investigation was compatible with a severe type II mixed cryoglobulinemia with multisystemic involvement, including a low-grade B cell lymphoma and concomitant intestinal tuberculosis. Initial management with immunosuppressive therapy with glucocorticoids to control symptoms and simultaneous tuberculosis treatment was required. Unavailability of adequate antiviral treatment led to the need to control the severity of systemic manifestations with rituximab, before the effective aetiological treatment with sofosbuvir and ledipasvir was possible, allowing the definitive resolution of the disease.