Mixed cryoglobulinemia

Boyer O, Saadoun D, Abriol J, Dodille M, Piette JC, Cacoub P, Klatzmann D CD4+CD25+ regulatory T-cell deficiency in patients with hepatitis C-mixed cryoglobulinemia vasculitis. Blood 2004 103 3428-3430. 

Agnello, V. Mixed cryoglobulinemia and hepatitis C virus. Hospital Pract. 1995 30 35-42... 

In a patient with type II mixed cryoglobulinemia, intravenous immunoglobulin caused severe cutaneous vasculitis accompanied by an increased cryocrit (98). 

Ferri C, Marzo E, Longombardo G, Lombardini F, La Civita L, Vanacore R, Liberati AM, Gerli R, Greco F, Moretti A, et al. Interferon-alpha in mixed cryoglobulinemia patients a randomized, crossover-controlled trial. Blood 1993,81 1132-1136... 

Recognized in 1961 (KIO), these are now well described (B18) and mimic the syndrome of mixed cryoglobulinemia (see 6.13). Skin lesions in this condition are raised, painful, and edematous with or without necrosis. Biopsy always reveals arteritis with a mononuclear and neutro-phile infiltrate. There is in most cases a preceding history of rheumatoid arthritis, Sjogren s syndrome, syphilis, sarcoidosis or other hyperimmune states, and this will dominate the clinical findings. Rarely the protein interactions build up to a level presenting as a viscosity syndrome so that this group can overlap with 7.7.1 unless the serum is carefully examined. 

Miadonna A, Tedeschi A, Leggieri E, Invernizzi F, Zanussi C Basophil activation in idiopathic mixed cryoglobulinemia. J Clin Immunol 1982 2 309-313. 

Gorevic PD, Kassab HJ, Levo Y, Kohn R, Meltzer M, Prose P, Franklin EC Mixed cryoglobulinemia clinical aspects and long-term follow-up of 40 patients. Am J Med 1980 69 287-308. 

Immunologic In hepatitis C virus-associated mixed cryoglobulinemia vasculitis, rituxi-mab may form a complex with rheumatoid factor-positive IgMK, leading to accelerated cryoprecipitation and severe systemic reactions [159 ]. 

Franklin and Frangione (25) made the interesting observation that one patient with mixed cryoglobulinemia, possessing IgM with anti-IgG activity, also had multiple myeloma. Associated with the disease was an IgA myeloma protein which lacked anti-IgG activity but, nevertheless, shared idiotypic specificity with the IgM antiglobulin present in the same serum. Other examples of individuals having two different monoclonal proteins with shared idiotypic specificity are discussed in Section VIII,... 

Hematologic Catastrophic multiple organ ischemia due to an anti-Pr cold agglutinin has been reported in a patient with mixed cryoglobulinemia after treatment with rituximab [297 ]. 

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