Cryoglobulinemic Vasculitis Associated with Monoclonal Gammopathy of Undetermined Significance Developed after Sustained Virologic Response of Hepatitis C: A Case Report

Michinori Ishitoku; Yusuke Yoshida; Toshiki Matsubara; Kenji Fujii; Ai Yorishima; Naoya Oka; Sho Masuda; Tomohiro Sugimoto; Sho Mokuda; Takao Masaki; Shintaro Hirata

doi:10.2169/internalmedicine.9768-22

This article has now been updated. Please use the final version.

Cryoglobulinemic Vasculitis Associated with Monoclonal Gammopathy of Undetermined Significance Developed after Sustained Virologic Response of Hepatitis C: A Case Report

Michinori Ishitoku, Yusuke Yoshida, Toshiki Matsubara, Kenji Fujii, Ai Yorishima, Naoya Oka, Sho Masuda, Tomohiro Sugimoto, Sho Mokuda, Takao Masaki, Shintaro Hirata

Author information

Michinori Ishitoku
Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
Yusuke Yoshida
Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
Toshiki Matsubara
Postgraduate Clinical Training Center, Hiroshima University Hospital, Japan
Kenji Fujii
Department of Nephrology, Hiroshima University Hospital, Japan
Ai Yorishima
Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
Naoya Oka
Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
Sho Masuda
Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
Tomohiro Sugimoto
Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
Sho Mokuda
Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan
Department of Rheumatology, Medical Corporation JR Hiroshima Hospital, Japan
Takao Masaki
Department of Nephrology, Hiroshima University Hospital, Japan
Shintaro Hirata
Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan

Keywords: hepatitis C virus infection, cryoglobulin, cryoglobulinemic vasculitis, monoclonal gammopathy of undetermined significance

JOURNAL OPEN ACCESS Advance online publication

Article ID: 9768-22

DOI https://doi.org/10.2169/internalmedicine.9768-22

The final version of this article is now available: Vol. 62 (2023), No. 13 pp. 1999-2004

Details

Abstract

A 72-year-old woman had a history of chronic hepatitis C virus (HCV) infection previously treated with interferon to achieve a sustained virologic response. Thereafter, she developed polyarthritis and purpura of the lower extremities as well as progressive renal dysfunction with hypertension and proteinuria that had occurred in the last three months. Laboratory investigations revealed seropositivity for cryoglobulin but negative findings for HCV RNA. She was ultimately diagnosed with cryoglobulinemic glomerulonephritis complicated by monoclonal gammopathy of undetermined significance (MGUS) based on the pathological findings of the kidney and bone marrow, indicating that MGUS-induced cryoglobulinemic vasculitis may occur even after HCV elimination.

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