Cryoglobulinaemia: clinical features and response to treatment [published erratum appears in Ann Med Interne (Paris) 1986;137(5):436]

Important note: Information in this article was accurate in 1987. The state of the art may have changed since the publication date.

Cryoglobulinaemia: clinical features and response to treatment [published erratum appears in Ann Med Interne (Paris) 1986;137(5):436]

Ann Med Interne (Paris). 1986;137(3):251-3. Unique Identifier : AIDSLINE MED/87024206
Singer DR; Venning MC; Lockwood CM; Pusey CD

Abstract: We report the clinical features and outcome of 16 patients with cryoglobulinaemia. Two patients with Type I cryoglobulinaemia both had IgG kappa monoclonal paraproteins. Nine of 10 with Type II disease had monoclonal IgM kappa and polyclonal IgG; one had monoclonal IgG kappa and polyclonal IgG in the cryoglobulin. Underlying disorders identified in 3 of the 4 Type III patients were Sjogren's syndrome, infective endocarditis, and non-A non-B hepatitis and HTLV III infection. The commonest presenting features were rash in 94 p. 100 (ulceration 25 p. 100), arthralgia in 63 p. 100 (erosive arthritis 32 p. 100), renal disease in 63 p. 100, neurological involvement in 56 p. 100, hepatomegaly in 32 p. 100 and splenomegaly in 32 p. 100. Major associated conditions were progressive bronchiectasis in one case, and severe peripheral vascular disease in another; underlying malignancy was found in 2 cases (lymphoma and malignant melanoma). Treatment was with plasma exchange (PE) and immunosuppressive drugs (ID) in 10, PE alone in 3, ID alone in 2 and antibiotics [corrected] in 1. Fourteen of 16 patients showed an initial clinical response and fall in cryoglobulin levels. Four patients have died, one each from gastro-intestinal haemorrhage, sepsis, pulmonary embolism and lymphoma. Of the remaining 12 patients, all are symptomatically controlled and 10 have persisting cryoglobulinaemia (3 on PE and ID, 2 on PE, 2 on ID and 3 on no treatment). Of the two cases in whom cryoglobulinaemia resolved, one (Type II) had received PE and ID and the other (Type III) had been treated with antibiotics and surgery for infective endocarditis.

Keywords: Adult Aged Cryoglobulinemia/*DIAGNOSIS/THERAPY Cryoglobulins/ANALYSIS Cyclophosphamide/THERAPEUTIC USE Female Human Immunosuppressive Agents/THERAPEUTIC USE Male Middle Age Plasma Exchange Prednisolone/THERAPEUTIC USE Time Factors JOURNAL ARTICLE

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