Influenza vaccination-associated cryoglobulinemic vasculitis

Mixed cryoglobulinemia is a small vessel vasculitis associated with viral infections, mainly hepatitis C virus, however, other important causes include lymphoproliferative and autoimmune disorders. Influenza vaccine-induced cryoglobulinemia has been rarely reported. A 68-year-old male presented on three occasions following influenza vaccination with purpuric rash and lower extremities swelling. His lab work showed mixed cryoglobulins. On his most recent presentation, in addition to the purpura, he presented with thrombocytopenia and nephritic syndrome. A kidney biopsy showed endocapillary proliferative glomerulonephritis with organized deposits, consistent with mixed type cryoglobulinemic glomerulonephritis. The patient was treated with rituximab infusion with progressive improvement of the acute kidney injury (AKI) and complete recovery. It is unclear why cryoglobulins are produced as a response to a vaccination, but this association is important to be aware of for prompt monitoring and treatment.