Browsing by Subject "Cryoglobulinemia"

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    Polyneuropathy: A Rare and Challenging Presentation of Essential Mixed Cryoglobulinemia
    (Sage, 2021) Taha, Ahmed; Taha, Mohamed; Ahmed, Roaa; Meckler, Gianna; Aeddula, Narothama; Meckler, Jason; Medicine, School of Medicine
    A 49-year-old male presented with acute chronic sensory motor bilateral lower extremity polyneuropathy. Electromyography showed bilateral acute sensory motor axonal polyneuropathy. Lumbar spine magnetic resonance imaging showed diffuse bone marrow replacement and bilateral ankylosing spondylitis. Laboratory workup revealed elevated inflammatory markers and low G6PD (glucose-6-phosphate dehydrogenase) level. Due to elevated acute phase reactants, inflammatory polyneuropathy was suspected; patient was treated accordingly with resolution of neuropathy. Three months later, he relapsed and presented with disabling polyneuropathy and renal impairment, which prompted renal biopsy. Renal histopathology revealed the, otherwise mysterious, etiology, essential mixed cryoglobulinemia. Essential mixed cryoglobulinemia was not considered initially due to the absence of classic systemic manifestations of autoimmune disorders.
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    Spectrum of Kidney Diseases in Patients With Hepatitis C Virus Infection
    (Oxford University Press, 2021) Guo, Shunhua; Kapp, Meghan E.; Beltran, Diego M.; Cardona, Cesar Y.; Caster, Dawn J.; Reichel, Ronald R.; Fogo, Agnes B.; Pathology and Laboratory Medicine, School of Medicine
    Objectives: To study the pathologic spectrum of kidney diseases in patients with hepatitis C virus infection (HCV+). Methods: Native kidney biopsy specimens in HCV+ patients were reviewed. Results: A total of 9,836 native kidney biopsy specimens were evaluated from January 2007 to December 2016, of which 273 (2.8%) were from HCV+ patients, and of these, 115 (42.1%) had diagnoses consistent with HCV-associated glomerulonephritis (GN). Non-HCV-associated kidney diseases comprised most diagnoses (158 cases, 57.9%) including non-immune complex-mediated kidney diseases (127 cases, 46.5%) and other immune complex-mediated glomerular diseases (31 cases, 11.4%). Forty-one (40.6%) patients had HCV-associated GN among 101 HCV+ patients from 2007 to 2011 vs 74 (43.0%) patients with HCV-associated GN among 172 HCV+ patients from 2012 to 2016. HCV-associated GN showed five morphologic patterns: focal proliferative (5.2%), diffuse mesangial proliferative (50.4%), diffuse membranoproliferative (28.7%), proliferative GN with crescentic lesions (7.8%), and membranous patterns (7.8%). Conclusions: We found a spectrum of pathologic changes in renal biopsy specimens of HCV+ patients, with most having diseases unrelated to HCV infection, HCV-associated GN showing five morphologic patterns, and availability of effective HCV antiviral therapy not yet resulting in major changes in the spectrum of kidney diseases in these patients.