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The complexity of an overlap type resistant cryoglobulinemia: a case report and review of the literature

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Abstract

Type I cryoglobulinemia is associated with B cell proliferative diseases, whereas essential mixed cryoglobulinemia is classically associated with infections, malignancy, and autoimmune diseases, but may be idiopathic. Prognosis in patients with grave manifestations and renal involvement is often poor. We report a case of a 40-year-old woman, 2 weeks post-partum for pre-eclampsia who was hospitalized with nephritic syndrome and acute renal failure. The patient harbored type I and type II cryoglobulinemia. Renal and cutaneous biopsies confirmed the diagnosis; however, an underlying etiology was not established. A bone marrow biopsy suggested monoclonal gammopathy of undetermined source (MGUS). Despite therapy with intravenous cyclophosphamide, rituximab, plasmapheresis, dialysis, and bortezomib, the patient succumbed after 8 months of hospitalization. We suggest that an overlap entity of types I and II cryoglobulinemia with severe multi-organ involvement not only is rare but also may be resistant to conventional therapy and fatal.

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Authors and Affiliations

  1. Department of Internal Medicine C, Wolfson Medical Center, 61 Halochamim Street, 58100, Holon, Israel

    Milena Tocut & Gisele Zandman-Goddard

  2. Department of Intensive Care, Wolfson Medical Center, Holon, Israel

    Ziv Rozman

  3. Department of Nephrology, Wolfson Medical Center, Holon, Israel

    Alexander Biro

  4. Department of Hematology, Wolfson Medical Center, Holon, Israel

    Asher Winder

  5. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Asher Winder, Amir Tanay & Gisele Zandman-Goddard

  6. Department of Rheumatology, Wolfson Medical Center, Holon, Israel

    Amir Tanay

Authors
  1. Milena Tocut
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  2. Ziv Rozman
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  3. Alexander Biro
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  4. Asher Winder
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  6. Gisele Zandman-Goddard
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Correspondence to Gisele Zandman-Goddard.

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Tocut, M., Rozman, Z., Biro, A. et al. The complexity of an overlap type resistant cryoglobulinemia: a case report and review of the literature. Clin Rheumatol 38, 1257–1262 (2019). https://doi.org/10.1007/s10067-018-04423-y

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  • DOI: https://doi.org/10.1007/s10067-018-04423-y

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