A Case of Type I Cryoglobulinemia Associated with Smoldering Myeloma and Acutely Reactivated Chronic Hepatitis B.
10.4078/jrd.2011.18.4.297
- Author:
Hyun Je KIM
1
;
Young Hoon HONG
;
Han Sol LEE
;
Min Jung KIM
Author Information
1. Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea. yhhongdr@yahoo.co.kr
- Publication Type:Case Report
- Keywords:
Cryoglobulinemia;
Chronic hepatitis B;
Smoldering myeloma
- MeSH:
Antibodies, Antineutrophil Cytoplasmic;
Atrophy;
Biopsy;
Blood Vessels;
Bone Marrow;
Cryoglobulinemia;
Erythrocytes;
Exanthema;
Hepatitis B;
Hepatitis B e Antigens;
Hepatitis B virus;
Hepatitis B, Chronic;
Hepatitis, Chronic;
Humans;
Hyalin;
Hypertension;
Immunoglobulin G;
Light;
Liver Function Tests;
Male;
Middle Aged;
Plasma Cells;
Polymerase Chain Reaction;
Rare Diseases;
Rheumatoid Factor;
Serologic Tests;
Skin;
Skin Ulcer
- From:Journal of Rheumatic Diseases
2011;18(4):297-301
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
A 58-year-old male patient with chronic hepatitis B infection and hypertension was referred for the evaluation of a skin rash. The skin biopsy showed multiple hyaline thrombi in small blood vessels, red blood cell extravasation, and epidermal atrophy. The CBC, chemistry, UA, and radiological studies were unremarkable except for elevated AST/ALT on liver function tests. The hepatitis B virus markers were compatible with the diagnosis of acute replicative phase chronic hepatitis B; HBeAg 86,646 cpm (count per minute), anti-HBeAb (-), HBV PCR (Quantitative) >1.10x108 IU/mL, and >640,200,000 copies/mL. Rouleaux formation was seen on the peripheral blood smears. Serum PEP/IEP demonstrated an M-spike (27.53%) in the gamma region and abnormal bowed arcs in IgG, kappa light chain with Cryoglobulin (+), ANCA (+), FANA (-), and rheumatoid factor (-) on the serological test. The percent of plasma cells on the bone marrow biopsy was approximately 15%. Type I cryoglobulinemia is a rare disease that can be associated with hematologic disorders, but smoldering myeloma or/and hepatitis B has not been reported in association with Type I cryoglobulinemia. Here, we report a case of Type I cryoglobulinemia that showed multiple skin ulcers due to vascular occlusion related to the monoclonal cryoglobulin with smoldering myeloma and acutely reactivated chronic hepatitis B.
