Essential mixed cryoglobulinemia type II.
We report a rare case of essential mixed cryoglobulinemia type II with membrano-proliferative glomerulonephritis (MPGN) type I in which HCV was not found. Long-term history of palindromic rheumatism, skin leukocytoclastic vasculitis attacks and micro-normocytic anemia preceded the appearance of cryoglobulinemia. Cryoprecipitate consisted of monoclonal IgMk-RF and polyclonal IgG (essential mixed type II). The newly appreciated cryoglobulinemia was associated with Coombs positive hemolytic anemia. The MPGN in this case had a benign course and responded to complex simple therapies including prevention of exposure to cold, low antigen content diet, treatment of provoking factors such as UTI, and maximal dose of ACE inhibitor. Responsiveness of skin vasculitis to colchicine therapy was restored after a two-month colchicine withdrawal period and therefore corticosteroid and immunosuppressive therapy was postponed.
Rozin
A P
AP
The 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
Lewin
M
M
Braun-Moscovici
Y
Y
Itzhak
O B
OB
Bergman
R
R
Balbir-Gurman
A
A
D000368:Aged; D000743:Anemia, Hemolytic / Q000150:complications / Q000473:pathology* / Q000628:therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000941:Antigens / Q000032:analysis; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003298:Coombs Test; D003449:Cryoglobulinemia / Q000150:complications / Q000473:pathology*; D004359:Drug Therapy, Combination; D005260:Female; D005526:Food, Formulated / Q000032:analysis; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications / Q000473:pathology* / Q000628:therapy; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D017257:Ramipril / Q000627:therapeutic use; D016896:Treatment Outcome; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000209:etiology / Q000473:pathology* / Q000628:therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D000941:Antigens; D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D017257:Ramipril; D003078:Colchicine