engleski

CRYOGLOBULINEMIA AND SENSORIMOTOR POLYNEUROPATHY: A CASE REPORT

Introduction/Objectives: Cryoglobulins are immunoglobulins that produce precipitate or gel in reduced temperatures. These precipitate dissolve when the temperature returns to normal values. Cryoglobulinemia can be essential - without a detectable underlying disease, or it can be secondary to other conditions, such as an infection (most commonly hepatitis C), lymphoproliferative or an autoimmune disease. It can lead to a variety of systemic complications, including peripheral neuropathy. Case report: A 69-year-old woman was admitted to the Department of Neurology due to progressive gait difficulties with distal motor weakness of extremities, tingling sensation in the hands and feet and skin changes. The symptoms began two years prior with gradual numbness of both hands and feet. Past medical history revealed arterial hypertension and operation of the kidney in the childhood that required a blood transfusion. Neurological examination at admission revealed distal motor weakness with hypotrophy, reduced sensation in the hands and feet, and absent Achilles reflexes, while the physical examination revealed skin ulcerations of the lower extremities. Laboratory testing showed elevated sedimentation rate (ESR) and C-reactive protein (CRP) levels, while immunological testing revealed normal ANA ; p-ANCA, cANCA, anti-CCP anti dsDNA levels, increased RF and CIC, C4 hypocomplementemia and positive cryoglobulin type III. Neuroradiological imaging (MR of the cervical and lumbar spine) did not reveal any significant findings, and the lumbar puncture revealed slightly increased protein level (0, 51 g/L) with normal cell counts (5 cells) and normal CSF glucose levels. Serologic studies for viral hepatitis were performed and came positive for HCV virus. Also, the skin biopsy was performed and revealed leukocytoclastic vasculitis with necrosis. The patient was diagnosed with cryoglobulinemia and treated with high doses of glucocorticosteroids while in the hospital. She was discharged home with prescribed immunosuppressive therapy (prednisone) and antiviral therapy (ombitasvir, paritaprevir and ritonavir) for hepatitis C. On follow-up exams there were a gradual and substantial recovery of skin lesions, eradication of chronic HCV infection with residual distal motor leg weakness. Conclusions: Hepatitis C infection is associated with a broad spectrum of manifestations and cryoglobulinemia is believed to be one of the most common extrahepatic expressions. The patients with cryoglobulinemia can develop various complications affecting multiple organ systems, and the most common neurological complication is distal sensorimotor polyneuropathy. In the clinical setting, it is important to think about the association between these conditions. Screening of the patients with hepatitis C infection by electrophysiological testing is necessary to detect patients with neurological complications in the early stages to begin treatment since they can be sometimes quite difficult and challenging to treat later on

cryoglobulinemia

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