title: Sudden onset of coma in a 70-year-old woman with cryoglobulinemia.
abstract: METHODS
  Female, 70 FINAL DIAGNOSIS: Chronic Heaptitis C Symptoms: Coma Medication: - Clinical Procedure: Plamapheresis Specialty: Neurology.
  
  
  OBJECTIVE
  Unusual clinical course.
  
  
  BACKGROUND
  Hepatitis C Virus (HCV)-related chronic hepatitis can be associated with mixed cryoglobulinemia (MC). Although several MC cases have been described, the wide variety of symptoms often makes diagnosis challenging.
  
  
  METHODS
  We describe a sudden onset of coma in a 70-year-old woman with an undiagnosed chronic hepatitis C infection related to MC. Head CT did not show any important pathology. Laboratory tests showed leucocytosis, but it was not possible to identify any pathogenic microorganism. Examination of cerebrospinal fluid did not show any pathology. There was a strongly positive test result for rheumatoid factor (409 U/l) and hypocomplementemia (C4 0.04 g/l). Laboratory assay was positive for antibodies against HCV and HCV RNA. The cryoglobulins were positive and after treatment with plasmapheresis her conditions improved.
  
  
  CONCLUSIONS
  In this case, the cryoglobulins laboratory exam was very helpful for the diagnosis. This test could be considered in the early management of elderly patients with sudden onset of coma.
authors: Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
authors: Gennaro
authors: G
authors: Pagano
authors: Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
authors: Klara
authors: K
authors: Komici
authors: Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
authors: Grazia Daniela
authors: GD
authors: Femminella
authors: Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
authors: Claudio
authors: C
authors: de Lucia
authors: Epilepsy Center, Department of Neurological Sciences, Federico II University of Naples, Naples, Italy.
authors: Marta
authors: M
authors: Ianniciello
authors: Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
authors: Dario
authors: D
authors: Leosco
authors: Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy ; Division of Cardiology, "Salvatore Maugeri" Foundation - IRCCS - Institute of Telese Terme, Telese Terme (BN), Italy.
authors: Nicola
authors: N
authors: Ferrara
authors: Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy ; Division of Cardiology, "Salvatore Maugeri" Foundation - IRCCS - Institute of Telese Terme, Telese Terme (BN), Italy.
authors: Giuseppe
authors: G
authors: Rengo
keywords: Chronic; Coma; Cryoglobulinemia; Hepatitis C; Plasmapheresis