Case Report
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World J Gastroenterol. Jan 14, 2013; 19(2): 304-306
Published online Jan 14, 2013. doi: 10.3748/wjg.v19.i2.304
Lesson from an intriguing case of cryoglobulinemia
Michele Barone, Raffaele Licinio, Annabianca Amoruso, Maria Teresa Viggiani, Angela Maria Vittoria Larocca, Alfredo Di Leo
Michele Barone, Raffaele Licinio, Annabianca Amoruso, Maria Teresa Viggiani, Alfredo Di Leo, Department of Emergency and Organ Transplantation, University of Bari, 70100 Bari, Italy
Angela Maria Vittoria Larocca, Department of Biomedical Science and Human Oncology, University of Bari, 70100 Bari, Italy
Author contributions: Barone M, Licinio R, Amoruso A, Viggiani MT and Larocca AMV contributed equally to this work; Di Leo A approved the final version.
Correspondence to: Alfredo Di Leo, Professor, Department of Emergency and Organ Transplantation, University of Bari, Policlinico G. Cesare Sq 11, 70124 Bari, Italy. alfredo.dileo@uniba.it
Telephone: +39-80-5592577 Fax: +39-80-5593251
Received: May 5, 2012
Revised: July 30, 2012
Accepted: August 14, 2012
Published online: January 14, 2013
Abstract

Cryoglobulinemia is a pathological condition usually associated with hepatitis C virus (HCV) chronic liver disease and less commonly with autoimmune or lymphoproliferative disorders. The possible association of cryoglobulinemia with hepatitis B virus (HBV) infection is not widely accepted. In our patient, serum negativity for HCV markers initially led us to consider two other causes of cryoglobulinemia. Myelodysplastic disorders were excluded on the basis of hematological studies, while serum markers for active HBV infection were positive. Surprisingly, the detection of HCV RNA in the cryocrit, even in the absence of anti-HCV antibodies, suggested a pathogenetic role of HCV in this case of cryoglobulinemia. Negative “first level” tests for HCV in the serum do not completely exclude HCV involvement in the pathogenesis of cryoglobulinemia. Analysis of the cryoprecipitate is always essential for diagnosis.

Keywords: Cryocrit; Hepatitis B virus; Hepatitis C virus; Myelodysplastic disorders; Cryoglobulinemia