ArticleThe American journal of case reports2025
Mixed Cryoglobulinemia in the Setting of Monoclonal B-Cell Lymphocytosis and Monoclonal Gammopathy of Unknown Significance: A Case Report.
Article in The American journal of case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND Type II cryoglobulinemic vasculitis is a systemic syndrome that usually develops in the background of chronic HCV infection. Cases of non-hepatitis C (HCV)-related type II cryoglobulinemic vasculitis pose diagnostic and therapeutic challenges in patients with pre-existing hematologic and rheumatic conditions. CASE REPORT We present the case of an 82-year-old woman with a history of skin-limited hypocomplementemic urticarial vasculitis (HUV), monoclonal gammopathy of unknown significance (MGUS), and monoclonal B-cell lymphocytosis (MBL), with new-onset pericarditis, pleuritis, worsening rash, and acute kidney injury. Skin and renal biopsies confirmed a diagnosis of type II (mixed) cryoglobulinemic vasculitis. After an extensive infectious disease workup and an in-depth investigation on our patient's MGUS and MBL, none of the classic causative factors for non-infectious mixed-type cryoglobulinemia were identified. Ultimately, she was started on immunosuppressive treatment, despite which she experienced rapidly progressive disease with pulmonary involvement. Utilizing this case as a basis, we examine the challenges of treating non-HCV-related cryoglobulinemia in patients with complex medical histories. CONCLUSIONS We report a case of mixed cryoglobulinemia in the absence of infection and the presence of 2 premalignant hematologic disorders. Moreover, this case emphasizes the importance of conducting biopsies to differentiate between vasculitis syndromes with overlapping phenotypes, illustrates the diagnostic challenges of recognizing cryoglobulinemia in a timely fashion in patients with pre-existing hematologic and autoimmune comorbidities, and highlights the need for better prognostic and diagnostic methods.
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