Diffuse alveolar hemorrhage: Rare presentation of type 1 cryoglobulinemia in marginal B-cell lymphoma

Abstract

Cryoglobulinemia (CG) is defined as the presence of abnormal immunoglobulins (Igs)that precipitate at low temperatures and dissolve upon warming. The manifestations in type I cryoglobulinemia are often related to intravascular obstruction which include skin, joint, renal and neurological involvement. We report a rare case of type 1 CG that presented with diffuse alveolar hemorrhage. Following extensive workup, the patient was found to have membranoproliferative glomerulonephritis secondary to type 1 CG in the setting of marginal B cell lymphoma. He was started on an aggressive regimen targeting underlying lymphoma. Key to managing this condition was multidisciplinary approach towards the diagnosis and management of this otherwise challenging case.

Keywords

• Type 1 cryoglobulinemia
• Diffuse alveolar hemorrhage
• Marginal B cell Lymphoma
• Pulmonary-renal syndrome
• Membranoproliferative glomerulonephritis