Materiały źródłowe

• #1 Cryoglobulinemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557606/

  Cryoglobulinemia is a rare medical condition characterized by the presence of abnormal proteins called cryoglobulins in the blood, which precipitate or clump together at low temperatures. These cryoglobulins can cause a range of symptoms, including joint pain, skin rashes, and kidney problems, due to their tendency to obstruct blood vessels and trigger inflammatory reactions. […] Diagnosis of this entity should be suspected in patients presenting with skin ulcers, arthralgia, glomerulonephritis, neuropathy, and purpura. […] Notable clinical features include arthralgias (44%), purpura (75%), skin ulcers (16%), glomerulonephritis (35%), and peripheral neuropathy (57%). […] The most prevailing symptom of mixed cryoglobulinemia is purpura, typically observed on the legs, extending up to the torso and/or upper extremities.

• #1 Cryoglobulinemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557606/

  The treatment of cryoglobulinemia depends on the underlying primary disorder, severity, and nature of organ involvement. […] The general onset of this disease is slow-paced, but in some situations, rapid progression can occur. […] Survival rates with cryoglobulinemia are 70% after 10 years of evident symptoms and approximately 50% 10 years after diagnosis. […] Renal complications of cryoglobulinemia occur in upward of half of the patients with HCV positivity, typically 3 to 5 years after the onset of purpura, and most commonly manifest as membranoproliferative glomerulonephritis.

• #2 Cryoglobulinemia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/870

  Cryoglobulinemia may be asymptomatic or present acutely. […] Clinical presentation includes a triad of purpura, weakness, and arthralgia. Multisystemic involvement may include the kidneys, liver, and nervous system. […] The clinical presentation includes a triad of purpura, weakness, and arthralgia. Multisystemic involvement may occur, particularly affecting the kidneys, liver, and nervous system.

• #3 Cryoglobulinemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/329255-overview

  Cryoglobulinemia is characterized by the presence of cryoglobulins in the serum. This may result in a clinical syndrome of systemic inflammation (most commonly affecting the kidneys and skin) caused by cryoglobulin-containing immune complexes. […] In a French study of 36 patients with type I cryoglobulinemia, skin or vasomotor symptoms were present in 75%; nephropathy in 30%; and neuropathy in 47%. […] Type I cryoglobulinemia may result in hyperviscosity due to high levels of circulating monoclonal cryoglobulin, leading to physical obstruction of vessels. […] The overall prognosis is worse in persons with concomitant renal disease, lymphoproliferative disease, or plasma cell disorders. Mean survival is approximately 50% at 10 years after diagnosis. […] Survival rates reported among patients with kidney involvement vary from greater than 60% at 5 years of follow-up to 30% at 7 years of follow-up. The risk of kidney failure appears to be greater in those with HCV-associated disease.

• #3 Cryoglobulinemia: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/329255-overview

  The prognosis in these patients depends on the presence of underlying diseases (eg, lymphoproliferative disorders, hepatitis B or C infection, connective-tissue disease), all of which increase the mortality rate over that of the healthy population and more accurately direct estimates of individual survival.

• #4 Cryoglobulinemia – Wikipedia

  https://en.wikipedia.org/wiki/Cryoglobulinemia

  Cryoglobulinemia is a medical condition in which the blood contains large amounts of cryoglobulins (atypical proteins) that become insoluble at low temperatures. […] The clinical features of cryoglobulinemic disease can appear due to the circulation of cryoglobulins. They can also appear due to an underlying hematological disorder, infectious disease, or autoimmune syndrome. […] The signs and symptoms in the increasingly rare cases of cryoglobulinemic disease that cannot be attributed to an underlying disease generally resemble those of patients suffering Type II and III (i.e., mixed) cryoglobulinemic disease. […] Signs and symptoms due to the cryoglobulins of type I disease reflect the hyperviscosity and deposition of cryoglobulins within the blood vessels, which reduce or stop blood perfusion to tissues.

• #4 Cryoglobulinemia – Wikipedia

  https://en.wikipedia.org/wiki/Cryoglobulinemia

  Types II and III (or mixed or variant) cryoglobulinemic disease may also present with symptoms and signs of blood hyperviscosity syndrome and deposition of cryoglobulins within blood vessels but also include those attributable to cryoglobulinemic vasculitis. „Meltzer’s triad” of palpable purpura, joint pain, and generalized weakness occurs in 33% of patients presenting with type II or type III disease. One or more skin lesions including palpable purpura, ulcers, digital gangrene, and areas of necrosis occur in 69-89% of these mixed disease cases.

• #5 Clinical presentation and outcomes of patients with type 1 monoclonal cryoglobulinemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5579826/

  We describe a series of 102 patients diagnosed from January 1, 1990 to December 31, 2015 with Type 1 monoclonal cryoglobulinemia (MoC). Symptoms were seen in 89 (87%) patients, including: cutaneous symptoms in 64 (63%) patients, with purpura (n = 43, 42%) and ulcers/gangrene (n = 35, 34%) being most common; neurological findings in 33 (32%) patients, most frequently sensory neuropathy (n = 24, 24%); vasomotor symptoms, mainly Raynauds phenomenon in 25 (25%); arthralgias in 24 (24%); and renal manifestations, primarily glomerulonephritis in 14 (14%) patients. […] Common symptoms related to cryoglobulinemia include purpura, livedo reticularis, cutaneous ulcers and gangrene; as well as vasomotor symptoms such as Raynauds phenomenon and acrocyanosis. Neurological findings are also frequent and are mainly characterized by peripheral neuropathy, though central nervous system (CNS) manifestations may be seen. Renal involvement can occur due to precipitation of cryoglobulins and characteristically presents as glomerulonephritis. Many patients also experience arthralgias.

• #5 Clinical presentation and outcomes of patients with type 1 monoclonal cryoglobulinemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5579826/

  Clinical symptoms were present in 89 (87%) patients at diagnosis. Sixty four (63%) patients had skin manifestations, with purpura being most common (67%), followed by ulcers or gangrene in 35 (55%) patients and livedo reticularis in 18 (28%) patients with cutaneous findings. Neurological symptoms were seen in 33 (32%) patients, with 30 (91%) of them presenting with peripheral neuropathy and 3 (9%) presenting with CNS involvement. Most patients (n = 24,80%) experienced sensory neuropathy, while 4 (13%) had mixed sensory and motor features and one patient presented with pure motor findings. Vasomotor symptoms were seen in 25 (25%) subjects, with 22 (88%) patients experiencing classic Raynauds phenomenon and five (20%) with acrocyanosis. […] Treatment was initiated in 73 (72%) patients, with median duration of treatment being 182 days (range: 12203). Treatment was initiated due to cryoglobulinemia-related symptoms in 57 (78%) patients, and two of these patients did not have an underlying hematologic disorder. Among patients receiving treatment (n = 73), the most common initial regimens were steroids with or without combination with alkylating agents in 29 (40%), followed by novel myeloma therapies (proteasome inhibitors and IMiD based treatment) in 16 (22%), rituximab with alkylating agents in 12 (16%) and rituximab with or without steroids in 11 (15%) patients.

• #6 Cryoglobulinemia and Multiple Myeloma: Treatment and Outlook

  https://www.healthline.com/health/multiple-myeloma/cryoglobulinemia-and-multiple-myeloma

  Cryoglobulinemia is a rare complication of multiple myeloma and other blood cancers that begin in a type of white blood cell called B cells. […] Many people with multiple myeloma who develop cryoglobulinemia experience severe skin symptoms, such as gangrene or areas of dead tissue called necrotic ulcers. […] About 69 to 86 percent of people with type 1 cryoglobulinemia have skin symptoms that can include: rash with red spots or purple discoloration (purpura), blotchy discoloration (livedo reticularis), white to purplish-blue color of hands, feet, nose, or ears (Raynaud’s phenomenon), blueness of hands and feet (acrocyanosis). […] Nearly half of people with type 1 cryoglobulinemia develop severe and potentially life-threatening symptoms like necrotic ulcers or gangrene. […] Other symptoms may include: unintentional weight loss, kidney or liver damage, numbness or tingling in the hands or feet, high blood pressure, trouble breathing, fatigue. […] Most people with myeloma who develop cryoglobulinemia experience skin symptoms. They often have severe symptoms such as necrotic ulcers or gangrene. These symptoms can be life threatening and require immediate medical attention.

• #7 Cryoglobulinemia Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/329255-clinical

  Specific clinical manifestations associated with type I cryoglobulinemia are related to hyperviscosity and thrombosis, as would be expected given the usual high concentrations of immunoglobulins and limited interference with complement function. These manifestations include the following: Acrocyanosis, Retinal hemorrhage, Severe Raynaud phenomenon with digital ulceration, Livedo reticularis, Purpura, Arterial thrombosis. […] Specific clinical manifestations associated with types II and III cryoglobulinemia include the following: Joint involvement (usually, arthralgias in the proximal interphalangeal [PIP] joints, metacarpophalangeal [MCP] joints, knees, and ankles), Fatigue, Myalgias, Kidney immune-complex disease, Cutaneous vasculitis, Peripheral neuropathy. […] Meltzer triad (ie, purpura, arthralgia, and weakness) was first described in 1966 by Meltzer and Franklin in cases of essential mixed cryoglobulinemia. This triad is generally seen with types II and III cryoglobulinemia and is seen in up to 25-30% of patients.

• #7 Cryoglobulinemia Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/329255-clinical

  Symptoms such as arthralgias and myalgias are rare in type I cryoglobulinemia and are common in types II and III disease. Frank arthritis and myositis are rare. Arthralgias commonly affect the proximal interphalangeal and metacarpophalangeal joints of the hands, knees, and ankles. Musculoskeletal symptoms are described in more than 70% of persons with cryoglobulinemia. […] Kidney disease may occur secondary to thrombosis (type I cryoglobulinemia) or immune complex deposition (types II and III). The incidence of kidney disease varies from 5-60%. Histologically, membranoproliferative glomerulonephritis is almost always the lesion in mixed cryoglobulinemia. Clinically, isolated proteinuria and hematuria are more common than nephrotic syndrome, nephritic syndrome, or acute kidney injury. Renal involvement is one of the most serious complications of cryoglobulinemia and typically manifests early in the course of the disease (within 3-5 y of diagnosis). Failure to treat may result in kidney failure.

• #7 Cryoglobulinemia Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/329255-clinical

  Neuropathy is common in types II and III disease (as determined with electromyographic and nerve conduction studies), affecting 70-80% of patients. Symptomatic disease was once reported as less common (5-40%); however, more recently, subjective symptoms have been reported up to 91% of patients. Sensory fibers are more commonly affected than motor fibers, with pure motor neuropathy in approximately 5% of patients.

• #8

  https://link.springer.com/article/10.1007/s12185-024-03911-z

  Type I cryoglobulinemia is typically associated with hematological malignancies such as B-cell lymphomas and plasma cell neoplasms. […] Symptoms of type I cryoglobulinemia are primarily related to vessel obstruction and inflammation, presenting as skin lesions (2886%) with necrosis occurring frequently (1028%), Raynauds syndrome (1331%), joint pain (1328%), kidney involvement (1435%), and peripheral neuropathy (1444%). […] The prognosis of type I cryoglobulinemia remains poor. […] The progression of skin necrosis, particularly in the knees and feet, persisted, leading us to prepare for above-knee amputation of both legs. […] Nine cycles in total were completed without severe non-hematological toxicity. With the subsequent ongoing carfilzomib maintenance, no progression of symptoms or re-emergence of cryoclots has been detected for over 3 years. […] This case highlights the difficulties in managing type I cryoglobulinemia. […] The presented case suggests that progressing necrotic lesions may serve as an indicator for proactive therapeutic intervention.

• #9 Mixed (Type II/III) Cryoglobulinemia – Vasculitides – Pathology – Picmonic for Medicine

  https://www.picmonic.com/pathways/medicine/courses/standard/pathology-196/vasculitides-39285/mixed-type-iiiii-cryoglobulinemia_50433

  Mixed cryoglobulinemia is characterized by rheumatoid factor activity with a mixture of monoclonal or polyclonal immunoglobulins. Clinical manifestations may include Meltzer’s triad, which is palpable purpura, arthralgias, and general malaise. […] Mixed cryoglobulinemia symptoms can be described by the Meltzer triad, which consists of palpable purpura (90-95% cases, particularly in lower extremities), weakness, and arthralgias This triad is present in 25-30% of cases. […] Purpuric lesions may be seen after standing or sitting for a long time This is known as orthostatic purpura. Ulceration and necrosis in the extremities can also develop. […] Arthralgias can be present in up to 70% of cases. They often occur in the proximal interphalangeal and metacarpophalangeal joint of the hands, as well as in the knees and ankles.

• #10 Cryoglobulinemia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cryoglobulinemia/symptoms-causes/syc-20371244

  Some people have no symptoms of cryoglobulinemia. For people who have symptoms, the symptoms might come and go. They can include: […] Most people with cryoglobulinemia get purple skin spots, called lesions, on their legs. On Black or brown skin, the spots might look black or brown. Some people also get open leg sores, called ulcers. […] Symptoms like those of rheumatoid arthritis are common in cryoglobulinemia. […] Cryoglobulinemia can damage the nerves at the tips of the fingers and toes. This causes numbness and other problems. […] Cryoglobulinemia can affect the kidneys. The main symptoms are protein or blood in the urine. High blood pressure most often goes with the kidney symptoms. In time, kidney failure might happen.

• #11 Cryoglobulinemia: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/318686

  Cryoglobulinemia is most common in adults over the age of 50. Some people experience continuous symptoms while others go through periods of flares. As cold temperatures play a role in cryoglobulinemia, people may experience flares during colder months and fewer symptoms in the summer. […] A person with cryoglobulinemia may or may not experience any symptoms. Some people may have low numbers of cryoglobulin in their blood and experience no symptoms. […] For others, symptoms may include: joint pain, fatigue, numbness, weakness, rash with red spots or purple bruises. […] Less common symptoms include: kidney damage, enlarged spleen or liver, swelling, particularly around ankles and legs, discoloration of the hands in the cold, weight loss, skin ulcers and gangrene, numbness or tingling, high blood pressure.

• #12 Cryoglobulinemia: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/13204-cryoglobulinemia

  People with cryoglobulinemia may or may not experience symptoms. When symptoms are present, they most commonly include a particular rash called purpura that looks like red spots or purple bruises, usually over your lower legs. You may also have fatigue and joint pain. […] Other cryoglobulinemia symptoms may include: Spasms in the blood vessels of your hands and/or feet with cold temperatures that cause them to turn blue (Raynauds phenomenon). Weight loss. High blood pressure (hypertension). Swelling (edema) of your ankles and legs. Skin ulcers and gangrene. Enlarged liver (hepatomegaly) or enlarged spleen (splenomegaly). Numbness, tingling or weakness in your hands or feet. Kidney damage. […] Left untreated, cryoglobulinemia can cause permanent skin, tissue and organ damage, including: Skin infections or ulcers. Skin death (necrosis). Kidney failure. Liver failure.

• #12 Cryoglobulinemia: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/13204-cryoglobulinemia

  In addition, the severity of the condition varies. Some people dont have any symptoms or have a very mild case that doesnt require treatment. For people with moderate to severe cases, prompt diagnosis and treatment can help relieve symptoms and prevent long-term complications. If you havent experienced any permanent damage to your organs, your prognosis is very good.

• #13 Cryoglobulinemic Vasculitis – Vasculitis Foundation

  https://vasculitisfoundation.org/education/vasculitis-types/cryoglobulinemic-vasculitis/

  Cryoglobulinemic vasculitis is a rare form of vasculitis characterized by inflammation of the blood vessels, which can restrict blood flow and damage vital organs and tissues. […] In this disease, abnormal blood proteins called cryoglobulins clump together at cold temperatures, restricting blood flow and causing damage to multiple organs, primarily the skin, muscles, nerves, and kidneys. It very rarely can affect the heart, brain, and gastrointestinal tract. […] The symptoms of cryoglobulinemic vasculitis vary depending on the organ systems affected. Some people may have no symptoms but are noted to have elevated cryoglobulin levels, which is detected in a blood test. When symptoms are present, they typically include the following: Rash with red spots and/or purplish discoloration from bleeding under the skin, mostly affecting the lower legs; hives may develop, as well as open sores (ulcers) and loss of tissue (necrosis), severe fatigue, joint pain, numbness, tingling and/or burning/pain sensation of the extremities, especially hands and feet, caused by nerve damage, muscle pain and weakness, discoloration of hands and feet in cold temperatures, swollen lymph nodes, abdominal pain, kidney damage (Note: A patient can have kidney damage without having symptoms; therefore, patients with vasculitis should have regular urine tests), headaches, stroke, chest pain, shortness of breath and swelling of the legs.

• #13 Cryoglobulinemic Vasculitis – Vasculitis Foundation

  https://vasculitisfoundation.org/education/vasculitis-types/cryoglobulinemic-vasculitis/

  Cryoglobulinemic vasculitis can be associated with severe complications such as kidney failure, necrosis of the skin, and permanent nerve damage. […] The outlook for cryoglobulinemic vasculitis depends on the presence of underlying diseases, the extent of organ damage, and how you respond to treatment. Some people don’t have symptoms and may not need treatment. For those with moderate to severe disease, appropriate and timely treatment can reduce symptoms, flare-ups, and prevent long-term complications. If permanent damage to nerves or internal organs has not occurred, the long-term prognosis is good. Because kidney disease is a concern with cryoglobulinemic vasculitis, ongoing monitoring of kidney function is important. For cryoglobulinemic vasculitis associated with HCV, effective antiviral therapy usually prevents recurrence of vasculitis.

• #14 Cryoglobulinemia: Symptoms, Diagnosis, Treatment, and More

  https://resources.healthgrades.com/right-care/symptoms-and-conditions/cryoglobulinemia

  Cryoglobulinemia symptoms vary depending on which organ systems are affected. Some people may not experience any symptoms at all. […] Those who do experience symptoms may have any of the following: purplish discoloration of the skin from bleeding under the skin, rash with red or discolored spots, hives, ulcers, or loss of tissue, joint pain, severe fatigue, numbness, tingling, or burning in the extremities, muscle pain or weakness, abdominal pain, discoloration of hands in cold temperatures. […] If cryoglobulinemia affects the brain, you may experience headaches or stroke. If it affects the heart, you may experience chest pain, difficulty breathing, and swelling in your legs. […] Many people with cryoglobulinemia do not experience any symptoms. However, symptoms may include skin discoloration from blood under the skin, fatigue, and muscle pain or weakness.

• #15 Cryoglobulinemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000540.htm

  Cryoglobulinemia is the presence of abnormal proteins in the blood. These proteins thicken in cold temperatures. […] Symptoms will vary, depending on the type of disorder you have and the organs that are involved. Symptoms may include: Breathing problems, Fatigue, Glomerulonephritis (kidney inflammation), Joint pain, Muscle pain, Purpura, Raynaud phenomenon, Skin death, Skin ulcers. […] Most of the time, mixed cryoglobulinemia does not lead to death. Outlook can be poor if the kidneys are affected. […] Complications include: Bleeding in the digestive tract (rare), Heart disease (rare), Skin infections or ulcers, Kidney failure, Liver failure, Skin death, Death.

• #16 Cryoglobulinemia | UNC Kidney Center

  https://unckidneycenter.org/kidneyhealthlibrary/glomerular-disease/cryoglobulinemia/

  The symptoms in type I occur because the blood is abnormally thick due to a high level of blood proteins. This can even lead to blood clots, or thrombosis. Skin symptoms are common. Raynauds phenomenon is a discoloration of the fingers and toes that happens when they are exposed to a change in temperature. Purpura are purple spotted rashes on the legs. Livedo reticularis is a blotchy purplish discoloration of the skin caused by impaired circulation. Acrocyanosis is blueness of the hands and feet that appear when small arteries toward the end of fingers and toes are blocked. Even gangrene can be present, which is a death of tissue from poor blood flow. […] Neurologic symptoms can occur due to reduced blood flow to the brain. These symptoms can include dizziness, double vision, sudden deafness, confusion, dementia, stroke, and coma.

• #17 Essential Mixed Cryoglobulinemia: Symptoms, Treatment

  https://www.medicinenet.com/essential_mixed_cryoglobulinemia/article.htm

  Cryoglobulins in the blood (cryoglobulinemia) can cause a variety of problems throughout the body. These include complications resulting from abnormal „thickness” of the blood (such as stroke or blood clots in the eyes leading to blindness) and inflammation of blood vessels, referred to as vasculitis. Vasculitis of arteries can result in blockage of blood flow, leading to damage to the organ(s) supplied by the affected blood vessels, such as in the skin, kidneys, or elsewhere. It can also cause bleeding when the blood vessels leak. […] Essential mixed cryoglobulinemia is characterized by joint pains and swelling (arthritis), enlargement of the spleen, skin vasculitis with purplish patches, and nerve and kidney disease. This can lead to recurrent pain in the abdomen, heart attack, and bleeding in the lungs. Weight loss can occur as well as poor appetite. […] The prognosis and natural history of the illness is not predictable. Kidney damage can be serious and some reports state that permanent failure of the kidney occurs in approximately 10% of patients. Death can occur, usually from serious heart disease, infection, or brain hemorrhage.

• #18 UT Health Austin | Cryoglobulinemia

  https://uthealthaustin.org/conditions/cryoglobulinemia

  Some people with cryoglobulinemia do not experience symptoms. For others, the symptoms come and go. […] Symptoms of cryoglobulinemia may include: Breathing difficulties, Muscle and/or joint pain, Numbness and discoloration of hands and feet, especially in cold temperatures, Rash with red or purple spots under the skin, Swollen lymph nodes, Weakness and/or fatigue.

• #19 Cryo Symptoms: Points to Consider – Alliance for Cryoglobulinemia

  https://allianceforcryo.org/cryo-symptoms-glens-points-to-consider/

  Sometimes cryoglobulinemia will present with very few symptoms externally, before you have a full-blown flare. […] You also need to be aware that cryoglobulinemia can affect any organ, and any system in the body. […] Keep these 14 points in mind when tracking your own symptoms. […] Malaise is a general feeling of “not well”. […] Muscle weakness. […] This is because people with cryo often experience muscle degeneration, or myopathy in the early stages of a flare and this means weak, sometimes sore muscles. […] General aches and pains, mostly sore muscles… just kind of achy and nondescript pain for a while before a flare. […] You simply feel tired. Your body is burning a lot of energy on a runaway immune system. […] Rapid weight loss. You will lose a lot of weight as the flare progresses.

• #19 Cryo Symptoms: Points to Consider – Alliance for Cryoglobulinemia

  https://allianceforcryo.org/cryo-symptoms-glens-points-to-consider/

  Splinter lesions under the fingernails are tiny blood-filled lesions under the nail that appear suddenly. […] Fever of unknown origin: You wind up running a fever with no apparent cause. […] I have had janeway lesions that form right at the corner where the end of the nail meets the skin. […] Arthralgia is arthritis like symptoms. […] Raynaud’s phenomena, the patriotic symptom: Sudden changes in blood circulation in the hands and/or feet. […] The RA-like swelling in the joints can cause stiffness and pain. […] Beyond the swelling caused by RA, you have edema, mostly in the lower legs, feet and ankles. […] A rash caused by tiny blood vessels rupturing and bleeding in the skin causing tiny ( < 2mm) papules to form. [...] Basically, patches of skin turn black and die. [...] Open sores that won’t heal. [...] This is a really scary looking event when it happens. [...] Mostly in the form of paresthesias (unusual sensations) caused by damage to the nerves in the hands, feet, arms, and lower legs. [...] In some cases the only presenting symptom of cryoglobulinemia is neuropathy.

• #20 Cryoglobulinemia: the “cold” problem in cardiac surgery, a single-center experience and a literature review | Journal of Anesthesia, Analgesia and Critical Care | Full Text

  https://janesthanalgcritcare.biomedcentral.com/articles/10.1186/s44158-024-00141-x

  Nervous system involvement in the course of CV ranges from 16 to 60%. Peripheral nervous system damage is usually represented by sensory-motor neuropathy of the lower limbs, paresthesia, loss of strength, pain, and burning sensations. […] CV-induced heart failure, reversible dilated cardiomyopathy, and hypertrophic cardiomyopathy have been also reported probably due to myocardial vessel involvement. […] Symptoms are usually characterized by blurred vision, recurrent epistaxis, headache, tinnitus, vertigo, and dizziness. In severe forms, ataxia, confusion, and heart failure may be present. […] Life-threatening conditions are represented by acute renal failure with oligo-anuria, rapidly progressive renal failure, diffuse alveolar hemorrhages, acute cerebrovascular and cardiovascular events, ischemic colitis, sepsis complicating skin ulcer infection, and critical liver failure.

• #21 Clinical characteristics, radiological features and outcomes in pulmonary involvement of cryoglobulinemia | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-024-03159-0

  Cryoglobulinemia with pulmonary involvement is rare, and its characteristics, radiological findings, and outcomes are still poorly understood. […] The pulmonary symptoms included dyspnea (50%), dry cough (30%), chest tightness (30%), and hemoptysis (10%). […] Patients with pulmonary involvement had significantly worse OS and progression-free survival than non-pulmonary involvement patients of cryoglobulinemia (P0.0001). […] A diagnosis of pulmonary involvement should be highly suspected for patients with cryoglobulinemia and chest CT-indicated infiltrates without other explanations. Patients with pulmonary involvement had a poor prognosis. Rituximab-based treatment may improve the outcome. […] Pulmonary involvement is rare in cryoglobulinemia. Pulmonary presentations vary from mild dyspnea to DAH, which is associated with high mortality. The chest CT scans mainly show diffuse GGOs. Patients of cryoglobulinemia with pulmonary involvement have a remarkably poor prognosis compared with non-pulmonary involvement patients with cryoglobulinemia. Rituximab-based treatment may be more effective.

• #22 What Is Cryoglobulinemia?

  https://www.icliniq.com/articles/blood-health/cryoglobulinemia

  Cryoglobulinemia is characterized by the abnormal precipitation of cryoglobulins in the patients serum leading to end-organ system failure. […] In cryoglobulinemia, abnormal immunoglobulins, known as cryoglobulins, coagulate together at very low temperatures, impeding the vascular blood supply and thereby damaging the nervous tissue, muscular tissue, skin, and various organs. […] The clinical manifestations of the disease include respiratory problems, cough, tiredness, arthralgia, myalgia, glomerulonephritis, isolated hematuria, erythematous pruritic purpura, skin rashes and ulcers, Raynaud’s phenomenon, skin infarction, headache and confusion, xerostomia, xerophthalmia, and petechiae. […] Meltzers triad is clinically presented in mixed variant cases, including palpable purpura, arthralgia, lethargy, fatigue, and weakness. […] The survival rate of individuals suffering from cryoglobulinemia is 70 percent after ten years and 50 percent after ten years after the treatment therapy. Delays in the treatment can lead to kidney and hematologic disorders.

• #23 Cryoglobulinemic Vasculitis – Vasculitis Syndromes – Rheumatology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.16.9.6.

  Cryoglobulinemic vasculitis (CV) is characterized by cryoglobulin deposits that affect small vessels (mainly capillaries, venules, or arterioles) and circulate in the blood. […] Clinical manifestations: 1) General symptoms include fatigue and low-grade fever. 2) Cutaneous manifestations: Palpable purpura in 90% of patients, usually on the lower extremities (cold triggers the appearance of new lesions), Raynaud phenomenon. 3) Renal manifestations associated with glomerulonephritis: Mainly peripheral edema and hypertension. 4) Nervous system manifestations: Peripheral polyneuropathy, cranial nerve involvement, central nervous system vasculitis. 5) Other manifestations: Arthralgia, myalgia. Less frequently, lymphadenopathy, hepatosplenomegaly, gastrointestinal symptoms. […] CV is frequently associated with exacerbations lasting 1 to 2 weeks followed by remissions lasting several days to months. With time, renal failure develops; renal involvement is associated with a less favorable prognosis. The most frequent cause of death is infection.

• #24 Cryoglobulinemia – MD Searchlight

  https://mdsearchlight.com/blood-disorders/cryoglobulinemia/

  Type II/III (mixed) Cryoglobulinemia: Commonly related to underlying symptoms like fatigue, joint pain, and muscular pain. Purpura (skin spots), which can be palpable or felt under the skin, and sensory changes due to peripheral neuropathy are also common. A combination of the commonly seen symptoms which include purpura, arthralgias (joint pain), and weakness, is referred to as the Meltzer triad, and is detected early in about 80% of the patients. The most common symptom here is purpura, often seen on the legs but can spread to the torso and upper body. These symptoms usually last for 1-2 weeks, with recurrent episodes occurring 1-2 times a month. […] A kidney biopsy can be used to determine the extent of the disease. […] Kidney complications are quite common among patients with cryoglobulinemia, particularly those that are HCV positive. These typically happen 3 to 5 years after the appearance of purple spots on the skin, and most often present as a form of kidney disease known as membranoproliferative glomerulonephritis. To assess the extent of the disease, a kidney biopsy can be carried out. The overall health outlook for this condition is not very good. Mild effects on the kidney can be managed with antiviral medication, while serious effects may warrant treatment with medication that suppress the immune system, along with steroids and a procedure to remove harmful substances from your blood (apheresis). But even if theres a long-term response to antiviral treatment, the affected organs often take a while to recover.

• #25 Cryoglobulinemia and Cryoglobulinaemic Vasculitis – Vasculitis UK

  https://www.vasculitis.org.uk/about-vasculitis/cryoglobulinemia-and-cryoglobulinaemic-vasculitis

  Cryoglobulinaemic Vasculitis symptoms include rash on the lower limbs, joint pain or arthritis, nerve damage, abdominal pain or kidney failure. […] Prognosis is determined by the underlying disease as well as other factors including age, and the severity of damage to any organs, especially the kidneys.

• #26 Cryoglobulinemia With Acronecrosis Not Associated With Hepatitis C Infection: A Case Report | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-cryoglobulinemia-with-acronecrosis-not-associated-articulo-S2173574311000827

  Cryoglobulinemia is a rare disease characterized by the production of monoclonal or polyclonal immunoglobulins that precipitate in cold temperature. […] The clinical manifestations of cryoglobulinemia symptoms can vary from only general and non-specific to joint pain, renal, neuropathic and skin involvement, which in a few cases can become acronecrosis. […] Here we present a case of essential mixed cryoglobulinemia not associated with hepatitis C infection, presented with symptoms of lower limb acronecrosis, which required amputation of several distal phalanges of the foot, despite an early diagnosis, as a result a poor response to treatment. […] Essential MC usually has a more aggressive course than those secondary to other diseases, with prevalence of renal, neuropathic and impaired peripheral circulation.

• #26 Cryoglobulinemia With Acronecrosis Not Associated With Hepatitis C Infection: A Case Report | Reumatología Clínica

  https://www.reumatologiaclinica.org/en-cryoglobulinemia-with-acronecrosis-not-associated-articulo-S2173574311000827

  Throughout the progression of our patient, we observed no control of peripheral involvement, which led to necrosis of the second and fourth fingers of the left foot, with subsequent amputation. […] This severe skin involvement occurs in only about 2% of cases and is due to vasculitis with fibrinoid necrosis and inflammation of the vessel wall and perivascular space, which most often affects the lower limbs, and can evolve to a chronic ulcer and gangrene, as in our patient. […] The particularity of this case is the presentation of one of the few cases of MC associated with no underlying disease (non-HCV), being therefore essential, and as mentioned in other articles, these cases have an abrupt clinical presentation and poor response to conventional therapy.

• #27 Cryoglobulinemia | The Foundation for Peripheral Neuropathy

  https://www.foundationforpn.org/causes/cryoglobulinemia/

  Cryoglobulinemia (which literally means “cold antibody in the blood”) refers to chemical properties of the antibodies that cause this disease. Cryoglobulins are antibodies that precipitate, or clump together, under cold conditions. People with cryoglobulinemia experience the characteristic symptoms – paleness, numbness, and pain in extremities, bleeding under the skin, and joint pain – when exposed to cold weather. […] Symptoms are prevalent in cold weather. […] Blanching, pain, numbness in fingers and toes (Raynaud’s phenomenon) […] Bleeding under the skin (purpura) […] General weakness […] Joint pain […] For peripheral neuropathy: Pain, numbness or tingling in the hands or feet. […] Diabetic neuropathy may suddenly flare up and affect a specific nerve or group of nerves. When this occurs, the result may be weakness and muscle atrophy in various parts of the body, such as involvement of the eye muscles or eyelid (e.g., causing double vision or a drooping eyelid) or thigh muscles. Alternatively, neuropathy caused by diabetes may slowly progress over time. It also can interfere with the normal functioning of the digestive system and sexual organs. […] Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers.

• #28 Cryoglobulins – Testing.com

  https://www.testing.com/tests/cryoglobulins/

  To determine if symptoms, like sensitivity of extremities to cold, are due to the presence of abnormal proteins called cryoglobulins in the blood, which can be associated with a variety of diseases […] When you have symptoms such as a rash, bruising, pain, weakness, joint pain, and/or paleness and coolness of the extremities that occur at cold temperatures […] The presence of large amounts of cryoglobulins in the blood, called cryoglobulinemia, can cause symptoms such as bruising, rashes, joint pain, weakness, and Raynaud phenomenon – pain, paleness, bluing, numbness, tingling and coldness in the fingers and toes with exposure to cold. […] The cryoglobulins test is ordered whenever a person has symptoms that may be associated with cryoglobulinemia. Some of these may include: Bruising, Rashes, purpura (purple patches), Joint, muscle pain, Weakness, fatigue, Raynaud phenomenon, which is characterized by pain, paleness, bluing, numbness, tingling and coldness in the fingers and toes with exposure to cold.

• #28 Cryoglobulins – Testing.com

  https://www.testing.com/tests/cryoglobulins/

  When the test is positive, it means that cryoglobulins are present and have the potential to precipitate upon exposure to cold. The symptoms experienced when this happens will vary from person to person, may be different with each exposure, and will not necessarily correlate with the quantity of cryoglobulins present. […] Most people who have cryoglobulinemia are chronically infected with hepatitis C virus (HCV), although not everyone with HCV (fewer than 3%) will develop cryoglobulinemia. […] Avoiding contact with cold objects and exposure to cold can help prevent or minimize symptoms. […] If they are due to a temporary condition, such as a bacterial infection, then they may go away when the infection resolves. If they are due to a chronic condition, such as an autoimmune disorder, then they are likely to persist.

• #29 Cryoglobulin and Cryofibrinogen Panel, Serum and Plasma – Mayo Clinic Laboratories | Neurology Catalog

  https://neurology.testcatalog.org/show/CRGSP

  Symptoms of cryoglobulinemia include purpura, Raynaud phenomenon, cyanosis, skin ulceration, gangrene, kidney failure, peripheral neuropathy, fever, and malaise. […] The majority of patients with cryoglobulins are asymptomatic. The type or quantity of cryoglobulin does not reliably predict whether or which symptoms will be present. […] The thermal amplitude (temperature at which the cryoglobulin precipitates) is a better predictor of symptoms than quantity or type.

• #30 CRGSP – Overview: Cryoglobulin and Cryofibrinogen Panel, Serum and Plasma

  https://www.mayocliniclabs.com/test-catalog/overview/83659

  Symptoms of cryoglobulinemia include purpura, Raynaud phenomenon, cyanosis, skin ulceration, gangrene, kidney failure, peripheral neuropathy, fever, and malaise. […] The majority of patients with cryoglobulins are asymptomatic. The type or quantity of cryoglobulin does not reliably predict whether or which symptoms will be present. […] Type I cryoglobulinemia is associated with monoclonal gammopathy of undetermined significance, macroglobulinemia, or multiple myeloma. […] Type II cryoglobulinemia is associated with autoimmune disorders such as vasculitis, glomerulonephritis, systemic lupus erythematosus, rheumatoid arthritis, and Sjogren syndrome. […] Type III cryoglobulinemia usually demonstrates trace levels of cryoprecipitate, may take up to 7 days to appear, and is associated with the same disease spectrum as Type II cryoglobulinemia.

• #31 Cryoglobulinaemia

  https://dermnetnz.org/topics/cryoglobulinaemia

  Cryoglobulinaemia is a rare disorder characterised by the presence of abnormal immunoglobulin proteins in the blood that can precipitate out into tissues at low temperatures and causing inflammation and damage. […] This causes restricted tissue blood flow and systemic inflammation, which leads to many clinical signs and symptoms including skin lesions, arthralgia (joint pain), arthritis, vascular purpura (purple skin marks), livedo (marbling pattern), and bleeding conditions. […] The clinical features of cryoglobulinaemia differ between the types as shown in the table below. […] Skin problems are almost always present in patients with cryoglobulinaemia. […] Many organs may be affected by cryoglobulinaemia. […] Identification and treatment of early symptoms such as skin lesions, fatigue or arthralgia, as a result of cryoglobulinaemia, will prevent further organ damage and improve patient outcomes.

• #32 Cryoglobulinemia | Lima Memorial Health System

  https://www.limamemorial.org/health-library/HIE%20Multimedia-TextOnly/1/000540

  Cryoglobulinemia is the presence of abnormal proteins in the blood. These proteins thicken in cold temperatures. […] Symptoms will vary, depending on the type of disorder you have and the organs that are involved. Symptoms may include: Breathing problems, Fatigue, Glomerulonephritis (kidney inflammation), Joint pain, Muscle pain, Purpura, Raynaud phenomenon, Skin death, Skin ulcers. […] Most of the time, mixed cryoglobulinemia does not lead to death. Outlook can be poor if the kidneys are affected. […] Complications include: Bleeding in the digestive tract (rare), Heart disease (rare), Skin infections or ulcers, Kidney failure, Liver failure, Skin death, Death. […] Contact your provider if: You develop symptoms of cryoglobulinemia, You have hepatitis C and develop symptoms of cryoglobulinemia, You have cryoglobulinemia and develop new or worsening symptoms.

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