Catastrophic multiple organ ischemia due to an anti-Pr cold agglutinin developing in a patient with mixed cryoglobulinemia after treatment with rituximab.
Cold agglutinin disease occurring with cryoglobulinemia is a rare occurrence. Here, we report a patient with mixed cryoglobulinemia that was treated with rituximab and, after response, developed an anti-Pr cold agglutinin that manifested with hemolysis and microvascular occlusion causing mesenteric ischemia and cerebral infarction. Unlike previous reports of patients with cryoglobulinemia and cold agglutinin disease, our patient did not have a detectable cryoprecipitate when his cold agglutinin manifested.
Ruch
Joshua
J
Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
McMahon
Brandon
B
Ramsey
Glenn
G
Kwaan
Hau C
HC
D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced* / Q000150:complications / Q000276:immunology / Q000628:therapy; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000918:Antibody Specificity; D001323:Autoantibodies / Q000276:immunology*; D001789:Blood Group Antigens / Q000276:immunology*; D002544:Cerebral Infarction / Q000209:etiology* / Q000276:immunology; D003131:Combined Modality Therapy; D003450:Cryoglobulins / Q000276:immunology*; D017809:Fatal Outcome; D013700:Giant Cell Arteritis / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007238:Infarction / Q000209:etiology / Q000276:immunology; D007422:Intestines / Q000098:blood supply* / Q000601:surgery; D007511:Ischemia / Q000209:etiology* / Q000276:immunology / Q000601:surgery; D007668:Kidney / Q000098:blood supply; D008099:Liver / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D010956:Plasmapheresis; D000069283:Rituximab; D013152:Splanchnic Circulation; D013154:Spleen / Q000098:blood supply
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies; D001789:Blood Group Antigens; D003450:Cryoglobulins; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; C493795:Pr antigen, human; D000069283:Rituximab