Type 2 mixed monoclonal IgM and polyclonal IgG cryoglobulinemia can be associated with concurrent renal and intestinal thrombosis: Case report
Three variants of cryoglobulinemic glomerulopathy are well known, however, the concurrent acute enteritis secondary to a mixed polyclonal cryoglobulin associated thrombotic vasculitis is rarely reported in the literature. We report a case of a 72-year-old man with medical history of hypertension, le...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | Human Pathology Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772736X22000172 |
| _version_ | 1828747045381341184 |
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| author | Sandeep Kumar Yazan Al-Othman Sami Zarouk Ping L. Zhang Zhenhong Qu |
| author_facet | Sandeep Kumar Yazan Al-Othman Sami Zarouk Ping L. Zhang Zhenhong Qu |
| author_sort | Sandeep Kumar |
| collection | DOAJ |
| description | Three variants of cryoglobulinemic glomerulopathy are well known, however, the concurrent acute enteritis secondary to a mixed polyclonal cryoglobulin associated thrombotic vasculitis is rarely reported in the literature. We report a case of a 72-year-old man with medical history of hypertension, leukocytoclastic vasculitis, positive serum cryoglobulin, hepatitis C, and membranoproliferative pattern of glomerulonephritis diagnosed 4 years ago. This patient recently presented with abdominal pain for one week. Labs showed worsening renal function, monoclonal IgM-kappa, and positive cryoglobulin in his serum, but negative hepatitis C test. The second renal biopsy showed a membranoproliferative pattern of glomerulopathy with many hyaline thrombi in the glomerular capillary loops. A mixed monoclonal IgM and polyclonal IgG cryoglobulinemic glomerulonephritis (type 2) was diagnosed. His concurrent jejunal biopsy revealed infiltration of neutrophils into glands and submucosal thrombus consistent with ischemic acute jejunitis. The submucosal thrombus of the jejunal biopsy was morphologically similar to the hyaline-thrombi found in glomerular capillary loops. Therefore, we concluded that cryoglobulin associated hyaline thrombi were the most likely etiology for both of his renal disease and acute ischemic jejunitis in this patient. This patient’s symptoms are due to simultaneous renal and intestinal thrombosis occurring in cryoglobulinemia. This concurrent thrombosis has not been well described in the literature. |
| first_indexed | 2024-04-14T04:35:39Z |
| format | Article |
| id | doaj.art-fb11f431ab844e07b47822db11ceacd7 |
| institution | Directory Open Access Journal |
| issn | 2772-736X |
| language | English |
| last_indexed | 2024-04-14T04:35:39Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Human Pathology Reports |
| spelling | doaj.art-fb11f431ab844e07b47822db11ceacd72022-12-22T02:11:54ZengElsevierHuman Pathology Reports2772-736X2022-03-0127300605Type 2 mixed monoclonal IgM and polyclonal IgG cryoglobulinemia can be associated with concurrent renal and intestinal thrombosis: Case reportSandeep Kumar0Yazan Al-Othman1Sami Zarouk2Ping L. Zhang3Zhenhong Qu4Department of Pathology, Beaumont Health, Royal Oak, MI, United StatesDepartment of Pathology, Beaumont Health, Royal Oak, MI, United StatesDivision of Nephrology, Department of Internal Medicine, Beaumont Health, Royal Oak, MI, United StatesDepartment of Pathology, Beaumont Health, Royal Oak, MI, United StatesDepartment of Pathology, Beaumont Health, Royal Oak, MI, United States; Corresponding author.Three variants of cryoglobulinemic glomerulopathy are well known, however, the concurrent acute enteritis secondary to a mixed polyclonal cryoglobulin associated thrombotic vasculitis is rarely reported in the literature. We report a case of a 72-year-old man with medical history of hypertension, leukocytoclastic vasculitis, positive serum cryoglobulin, hepatitis C, and membranoproliferative pattern of glomerulonephritis diagnosed 4 years ago. This patient recently presented with abdominal pain for one week. Labs showed worsening renal function, monoclonal IgM-kappa, and positive cryoglobulin in his serum, but negative hepatitis C test. The second renal biopsy showed a membranoproliferative pattern of glomerulopathy with many hyaline thrombi in the glomerular capillary loops. A mixed monoclonal IgM and polyclonal IgG cryoglobulinemic glomerulonephritis (type 2) was diagnosed. His concurrent jejunal biopsy revealed infiltration of neutrophils into glands and submucosal thrombus consistent with ischemic acute jejunitis. The submucosal thrombus of the jejunal biopsy was morphologically similar to the hyaline-thrombi found in glomerular capillary loops. Therefore, we concluded that cryoglobulin associated hyaline thrombi were the most likely etiology for both of his renal disease and acute ischemic jejunitis in this patient. This patient’s symptoms are due to simultaneous renal and intestinal thrombosis occurring in cryoglobulinemia. This concurrent thrombosis has not been well described in the literature.http://www.sciencedirect.com/science/article/pii/S2772736X22000172Mixed cryoglobulinemiaMonoclonal cryoglobulinemic glomerulonephritisIschemic jejunitisHepatitis C infection |
| spellingShingle | Sandeep Kumar Yazan Al-Othman Sami Zarouk Ping L. Zhang Zhenhong Qu Type 2 mixed monoclonal IgM and polyclonal IgG cryoglobulinemia can be associated with concurrent renal and intestinal thrombosis: Case report Human Pathology Reports Mixed cryoglobulinemia Monoclonal cryoglobulinemic glomerulonephritis Ischemic jejunitis Hepatitis C infection |
| title | Type 2 mixed monoclonal IgM and polyclonal IgG cryoglobulinemia can be associated with concurrent renal and intestinal thrombosis: Case report |
| title_full | Type 2 mixed monoclonal IgM and polyclonal IgG cryoglobulinemia can be associated with concurrent renal and intestinal thrombosis: Case report |
| title_fullStr | Type 2 mixed monoclonal IgM and polyclonal IgG cryoglobulinemia can be associated with concurrent renal and intestinal thrombosis: Case report |
| title_full_unstemmed | Type 2 mixed monoclonal IgM and polyclonal IgG cryoglobulinemia can be associated with concurrent renal and intestinal thrombosis: Case report |
| title_short | Type 2 mixed monoclonal IgM and polyclonal IgG cryoglobulinemia can be associated with concurrent renal and intestinal thrombosis: Case report |
| title_sort | type 2 mixed monoclonal igm and polyclonal igg cryoglobulinemia can be associated with concurrent renal and intestinal thrombosis case report |
| topic | Mixed cryoglobulinemia Monoclonal cryoglobulinemic glomerulonephritis Ischemic jejunitis Hepatitis C infection |
| url | http://www.sciencedirect.com/science/article/pii/S2772736X22000172 |
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