Rheumatology International

, Volume 28, Issue 5, pp 503–506

Cryoglobulinaemia type III with severe neuropathy and immune complex glomerulonephritis: remission after plasmapheresis and rituximab

Authors

    • University of Heidelberg, Bethanien Hospital
    • Department of Internal Medicine III, Division of Rheumatology and OsteologyUniversity of Jena
  • Thomas Neumann
    • Department of Internal Medicine III, Division of Rheumatology and OsteologyUniversity of Jena
  • Peter Oelzner
    • Department of Internal Medicine III, Division of Rheumatology and OsteologyUniversity of Jena
  • Gert Hein
    • Department of Internal Medicine III, Division of Rheumatology and OsteologyUniversity of Jena
  • Hermann-Josef Gröne
    • German Cancer Research Centre
  • Mirjana Ziemer
    • Department of DermatologyUniversity of Jena
  • Gunter Wolf
    • Department of Internal Medicine III, Division of Rheumatology and OsteologyUniversity of Jena
Case Report

DOI: 10.1007/s00296-007-0462-y

Cite this article as:
Braun, A., Neumann, T., Oelzner, P. et al. Rheumatol Int (2008) 28: 503. doi:10.1007/s00296-007-0462-y

Abstract

We describe the case of a 78-year-old woman with peripheral neuropathy, neurogenic muscular atrophy, skin ulcers, arthritis and immune complex glomerulonephritis. Detection of mixed cryoglobulins in combination with typical clinical symptoms, and the exclusion of hepatitis C and other underlying diseases, led to the rare diagnosis of essential cryoglobulinaemic vasculitis type III. Because initial interventions with prednisolone, plasmapheresis and cyclophosphamide pulse therapy failed to induce remission, therapy with rituximab, a chimeric monoclonal antibody that reacts specifically with the CD20 antigen, was initiated. Rituximab was administered intravenously at a dose of 375 mg/m2 body surface. After five applications, the patient showed remission of clinical symptoms and complete normalisation of laboratory values. These results suggest that rituximab is an alternative therapeutical approach with strikingly good clinical outcome in patients with cryoglobulinaemic vasculitis type III.

Keywords

CryoglobulinaemiaType IIIVasculitisRituximabGlomerulonephritis

Copyright information

© Springer-Verlag 2007