Cryoglobulinemia - Diagnosis and Management Summary
Immune ...

Cryoglobulinemia - Diagnosis and Management Summary

Immune Complex-Associated Small-Vessel Vasculitis - Immunoglobulins that precipitate at low temperatures and re-dissolve on rewarming

Type 1: Monoclonal (usually IgM or IgG), associated with Waldenstrom’s, MM

 • Sx: peripheral neuropathy, renal impairment, hyperviscosity (Raynaud’s, digital ischemia, livedo), vasculitis

Type 2: “Mixed” monoclonal IgM against polyclonal IgG (often IgM with RF activity), associated with HCV, HIV, HBV, EBV

Type 3: “Mixed” polyclonal Ig (IgM or IgG) against polyclonal Ig (IgM or IgG), associated with CTDs, lymphoproliferative disorders, HCV

 • Sx: palpable purpura, arthralgias, myalgias

Rx: Treat underlying cause (e.g., HCV); prednisone ± 2nd immunosuppressive agent (RTX, CYC); consider plasma exchange for Type 1

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