1/6. Cutaneous ulcers with type I cryoglobulinemia treated with plasmapheresis.Severe necrotic cutaneous ulcers and kidney involvement secondary to type I cryoglobulinemia can be a therapeutic challenge. plasmapheresis has been reported useful to treat autoimmune diseases such as thrombotic thrombocytopenic purpura, systemic lupus erythematosus, myasthenia gravis and Goodpasture's syndrome. We report the case of a patient who presented necrotic lesions with kidney involvement due to type I cryoglobulinemia (Ig G kappa) that evolved to a multiple myeloma. Treatment with high doses of corticosteroid plus cyclophosphamide did not control the disorder. Therapy with plasmapheresis produced a marked decrease in cryoglobulin levels and a subsequent relevant clinical improvement of cutaneous lesions and renal function. In cryoglobulinemia, plasmapheresis can be used as effective adjunt therapy to minimize cutaneous, renal and/or neurologic involvement.- - - - - - - - - - ranking = 1keywords = cryoglobulinemia (Clic here for more details about this article) |
2/6. Type III mixed cryoglobulinemia associated with digital necrotic ulcer successfully treated with intermittent intravenous pulse cyclophosphamide--a case report.Cryoglobulinemic vasculitis is an immune complex-mediated vasculitis predominantly affecting small vessels. The authors report an 18-year-old woman with painful digital necrotic ulcer due to type III cryoglobulinemic vasculitis on the basis of systemic lupus erythematosus. serum protein electrophoresis and immunoelectrophoresis demonstrated a polyclonal peak of the immunoglobulin Glambda (IgGlambda) and IgMlambda type. The patient was successfully treated with intermittent intravenous pulse cyclophosphamide.- - - - - - - - - - ranking = 0.57142857142857keywords = cryoglobulinemia (Clic here for more details about this article) |
3/6. Pseudothrombocytosis and pseudoleukocytosis in a case of essential mixed cryoglobulinemia (type II).Pseudothrombocytosis and pseudoleukocytosis occurred in a patient with essential mixed cryoglobulinemia (EMC) and atypical cutaneous ulcers, when the blood cell counts were estimated by the Model S Plus Coulter Counter. The spurious cell counts were found in serum as well as in plasma and whole blood, so the involvement of fibrinogen in this phenomenon is questioned. When timed serial counts were performed on whole blood at room temperature the highest value of WBCs was detected one hour after sample collection and that of platelets occurred at 6 hours, when leukocytosis had disappeared. Possible explanations for this phenomenon are offered.- - - - - - - - - - ranking = 0.71428571428571keywords = cryoglobulinemia (Clic here for more details about this article) |
4/6. The effect of combination therapy (steroids, immunosuppressives, and plasmapheresis) on 5 mixed cryoglobulinemia patients with renal, neurologic, and vascular involvement.A prospective clinical study evaluated the effects of combined chemotherapy, steroids and plasmapheresis on 5 patients with mixed cryoglobulinemia with renal or neurologic and vasculitic manifestations. Treatment included prednisone (1mg/kg/day), chlorambucil (white blood cell count at greater than 3,000/mm3), and plasmapheresis (1 to 3 liters/week). There was healing of cutaneous ulcers (3/3), improvement in renal function (4/4), and diminution of purpura (2/2), but little improvement in peripheral neuropathy. Complications included leukopenia, perineal ulcers, and osteomyelitis.- - - - - - - - - - ranking = 0.71428571428571keywords = cryoglobulinemia (Clic here for more details about this article) |
5/6. Spontaneous necrosis of the skin associated with cryofibrinogenemia, cryoglobulinemia, and homocystinuria.Cryofibrinogenemia has been associated with a variety of skin manifestations including purpura, livedo reticularis, and ulceration. Our patient, who had undergone axillobifemoral bypass 5 years previously, presented following the spontaneous development of a necrotic wound involving the left groin scar. The location of the wound suggested the possibility of underlying graft infection, but indium-111 white blood cell scan and MRI failed to show any evidence of infection. The patient was initially treated with oral antibiotics and outpatient debridement with no improvement. A more aggressive approach with inpatient operative debridement and intravenous antibiotics produced moderate improvement. Three months later, the patient developed an identical necrotic wound in the right groin and subsequently a third lesion involving a scar distant from any of the patient's grafts. No evidence of active vasculitis was seen on microscopic examination of the excised tissues. Cryoglobulin and cryofibrinogen assays were positive, and urinary and plasma homocysteine levels were elevated. The patient was subsequently treated with stanozolol, a low-methionine diet, and outpatient intravenous antibiotics with rapid improvement of her wounds. In patients with spontaneous ulceration of the extremities, particularly when they do not respond appropriately to standard therapy, the possibility of cryoglobulinemia or cryofibrinogenemia should be considered.- - - - - - - - - - ranking = 0.71428571428571keywords = cryoglobulinemia (Clic here for more details about this article) |
6/6. Mixed-cryoglobulinemia associated with cutaneous vasculitis and pulmonary symptoms.A 45-year-old Japanese man with sjogren's syndrome developed recurrent skin ulcers, palpable purpura, and dyspnea. serum mixed-type cryoglobulin level was elevated. A biopsy of his skin lesion showed the characteristic leukocytoclastic vasculitis of mixed-type cryoglobulinemia. dyspnea, skin ulcers, and purpura resolved along with a reduction in the serum cryoglobulin level after prednisolone administration. This patient demonstrated cryoglobulinemia-associated vasculitis, as well as possible cryoglobulinemia-associated pulmonary symptoms.- - - - - - - - - - ranking = 1keywords = cryoglobulinemia (Clic here for more details about this article) |