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Essential mixed cryoglobulinemia type II.

A P Rozin1, M Lewin, Y Braun-Moscovici

  • 1The B. Shine Department of Rheumatology, Rambam Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. a_rozin@rambam.health.gov.il

Clinical and Experimental Rheumatology
|July 28, 2006
PubMed
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This study details a rare case of essential mixed cryoglobulinemia type II and membranoproliferative glomerulonephritis type I without HCV. Management involved cold avoidance, diet, UTI treatment, and ACE inhibitors, successfully treating vasculitis and anemia.

Area of Science:

  • Nephrology
  • Rheumatology
  • Hematology

Background:

  • Essential mixed cryoglobulinemia (EMC) type II is a rare condition often associated with Hepatitis C Virus (HCV).
  • Membranoproliferative glomerulonephritis (MPGN) type I can be a manifestation of systemic immune dysregulation.
  • Prior history of palindromic rheumatism and leukocytoclastic vasculitis can precede cryoglobulinemia development.

Observation:

  • A rare case of EMC type II with MPGN type I was observed in a patient negative for HCV.
  • The patient presented with a history of palindromic rheumatism, vasculitis, and anemia preceding cryoglobulinemia.
  • Cryoprecipitate analysis revealed monoclonal IgMk-RF and polyclonal IgG, characteristic of essential mixed type II cryoglobulinemia.

Findings:

  • The cryoglobulinemia was linked to Coombs-positive hemolytic anemia.

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  • The MPGN exhibited a benign clinical course.
  • Therapeutic interventions including cold avoidance, dietary modifications, UTI management, and ACE inhibitors were effective.

    • Implications:

    • This case highlights a rare presentation of EMC type II and MPGN type I in the absence of HCV.
    • Successful management was achieved with conservative measures, avoiding immunosuppression initially.
    • Restored colchicine responsiveness after withdrawal suggests a potential role in managing associated vasculitis.