title: Purpura with ulcerative skin lesions and mixed cryoglobulinemia in a quiescent hepatitis B virus carrier.
abstract: Mixed cryoglobulinemia is occasionally seen in patients with hepatitis B virus (HBV) infection. This report presents the case of a quiescent HBV carrier who had type II mixed cryoglobulinemia, protracted purpura, ulcerative skin lesions and advanced chronic kidney disease. The cutaneous manifestations of the patient improved along with a decrease in the serum cryoglobulin and HBV-deoxyribonucleic acid levels following the initiation of oral entecavir in combination with plasmapheresis. However, the patient ultimately required prednisolone due to the limited benefits of these treatments. We also discuss various concerns regarding steroid treatment in patients with mixed cryoglobulinemia complicated by HBV infection.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Tetsu
authors.initials: T
authors.lastname: Akimoto
authors.forename: Kousuke
authors.initials: K
authors.lastname: Okuda
authors.forename: Taro
authors.initials: T
authors.lastname: Sugase
authors.forename: Eri
authors.initials: E
authors.lastname: Takeshima
authors.forename: Akihiko
authors.initials: A
authors.lastname: Numata
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Morishita
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Iwazu
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Yoshizawa
authors.forename: Takanori
authors.initials: T
authors.lastname: Komada
authors.forename: Kana
authors.initials: K
authors.lastname: Iwazu
authors.forename: Osamu
authors.initials: O
authors.lastname: Saito
authors.forename: Fumi
authors.initials: F
authors.lastname: Takemoto
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Muto
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusano
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003449:Cryoglobulinemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D003450:Cryoglobulins / Q000032:analysis; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006510:Hepatitis B Antibodies / Q000097:blood; D006511:Hepatitis B Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D010956:Plasmapheresis; D011239:Prednisolone / Q000627:therapeutic use; D011693:Purpura / Q000209:etiology*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications; D012883:Skin Ulcer / Q000209:etiology*
chemical_list: D000998:Antiviral Agents; D003450:Cryoglobulins; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006511:Hepatitis B Antigens; C413685:entecavir; D006147:Guanine; D011239:Prednisolone