[Intravenous immunoglobulin and prednisolone treatment of cryoglobulinemic polyneuropathy]

A 71-year-old man with cryoglobulinemia associated with severe symmetrical sensorimotor polyneuropathy was successfully treated with intravenous immunoglobulin (IVIG) and a corticosteroid. Within 2-3 months, he developed distal motor and sensory deficits and burning feet deteriorating after cold exposure. On examination, symmetric hypesthesia and hypalgesia were found along with bilateral loss of vibration and position sense, loss of ankle jerks, and paralysis of the pretibial muscles with step-page gait. The laboratory exam revealed elevated cryoglobulin levels and reduced complement C4. Nerve conduction studies were consistent with a severe axonal sensorimotor polyneuropathy. Sural nerve biopsy showed chronic neuropathy with an acute component. The patient underwent a combined treatment with prednisolone (initially 100 mg) and intravenous immunoglobulin. His condition markedly improved after almost a year of treatment. Unfortunately, the treatment with intravenous immunoglobulin had to be interrupted due to an allergic reaction after the sixth application.