An unusual case of cryoglobulinemic purpura in elderly patient

Abstract

Cryoglobulinemia is associated with infections, in particular chronic hepatitis C, autoimmune diseases, and lymphoproliferative disorders. Its frequency seems to be higher than is commonly considered, even in elderly patients. We describe the case of an elderly patient with diabetes, nephroangiosclerosis and purpura who presented marked and persistent increase in rheumatoid factor, hypocomplementemia and cryoglobulinemia with nephrotic disagreement unrelated to HCV. A thirteen‑month follow‑up showed neither immunorheumatologic nor neoplastic disorders. In literature, associations with hepatic pseudocyst is not described and a lack of association with HCV is very rare. Therefore, the hypothesis of “essential” mixed cryoglobulinemia (EMC) associated with nephrotic syndrome was formulated. Renal disease associated with EMC (unrelated to HCV) is characterized by the high prevalence of primary Sjögren syndrome and overt B‑cell non‑Hodgkin’s lymphoma for which repetitive clinical evaluation is necessary.

Keywords

• Cryoglobulinemia
• Rheumatoid Factor
• Complement
• Purpura
• Nephrotic syndrome
• Mixed essential cryoglobulinemia
• Elderly