Suspected thermal amplitude of cryoglobulin likely more clinically significant than size detected: A case report.
Senan Shortall, Aaron Niblock, Philip Logue et al.
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Case in brief
A patient with known lymphoplasmacytic lymphoma developed extensive necrosis of the fingers and toes. Testing detected a small type I cryoglobulin, but its significance was uncertain. Biopsy of tissue immediately proximal to the necrosis showed cryoglobulin occlusions, supporting a link to vascular injury. The patient also had chronic, stable haemolysis; testing of the red-cell antibody showed titres of 65,536 at 4°C, 2,048 at room temperature, and 1 at 37°C. The authors considered the antibody’s broad thermal amplitude a possible explanation for severe vascular damage despite the low cryoglobulin level.
What made this case unusual
Severe acral necrosis occurred with a small type I cryoglobulin; tissue biopsy confirmed vascular occlusions, while red-cell antibody testing suggested broad thermal activity that might help explain the injury.
Diagnostic / clinical pearl
When a small cryoglobulin level seems insufficient to explain acral necrosis, biopsy of tissue near the affected area can provide evidence of cryoglobulin-mediated vascular occlusion; thermal amplitude may also be relevant.