[Hepatitis associated cryoglobulinemia]

Cryoglobulins are immunoglobulins that precipitate at temperatures below 37 degrees C. Clinically cryoglobulinemia is manifested in a variety of symptoms on different organs. The most important clinical symptoms are fatigue, peripheral neuropathy and vasculitis associated skin lesions. Pathophysiologically cryoglobulinemia is based on a disturbed immunocascade with an elevated B-cell-activity. Often a cryoglobulinemia progresses smoothly to a Non-Hodgkin-Lymphoma. The main activator of a cryoglobulinemia is a Hepatitis C virus infection. Other causes for developing a cryoglobulinemia are rheumatological and haematological diseases. In the past cryoglubulinemia has predominantly been treated with plasmapheresis and immunosuppression, nowadays antiviral strategies are becoming more important. Cases of rapid worsening under therapy with interferon alpha have also been reported. A promising new option is the use of rituximab.