Diffuse alveolar hemorrhage: Rare presentation of type 1 cryoglobulinemia in marginal B-cell lymphoma

Cryoglobulinemia (CG) is defined as the presence of abnormal immunoglobulins (Igs)that precipitate at low temperatures and dissolve upon warming. The manifestations in type I cryoglobulinemia are often related to intravascular obstruction which include skin, joint, renal and neurological involvement. We report a rare case of type 1 CG that presented with diffuse alveolar hemorrhage. Following extensive workup, the patient was found to have membranoproliferative glomerulonephritis secondary to type 1 CG in the setting of marginal B cell lymphoma. He was started on an aggressive regimen targeting underlying lymphoma. Key to managing this condition was multidisciplinary approach towards the diagnosis and management of this otherwise challenging case.