SHM Converge Scientific Abstract ePoster Gallery-Monoclonal Mayhem: An Interesting Case of Type I Cryoglobulinemic Vasculitis Revealing Monoclonal Gammopathy of Clinical Significance

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This case describes a 76-year-old man with diabetes who presented with bloody diarrhea, worsening petechial rash on both legs, and lightheadedness after a recent trip to India. Initial evaluation showed severe hyponatremia, anemia, thrombocytopenia, and acute kidney injury. Stool testing was positive for E. coli O157:H7/ETEC/STEC, but early hemolysis studies and peripheral smear did not support thrombotic microangiopathy.<br /><br />During hospitalization, he developed oliguric renal failure requiring dialysis, along with paresthesias and worsening purpura involving his face. Further workup revealed low complement levels, negative autoimmune serologies, and a bone marrow biopsy without malignancy. A repeat smear showed proteinaceous deposits concerning for cryoglobulins, and serum cryoglobulins were elevated. Kidney biopsy demonstrated tubulointerstitial nephritis with a membranoproliferative pattern suspicious for cryoglobulinemic glomerulonephritis. Cryo-immunofixation identified type 1 cryoglobulinemia with monoclonal IgG kappa, and SPEP confirmed a gamma spike.<br /><br />He was diagnosed with type 1 cryoglobulinemic vasculitis due to monoclonal gammopathy of clinical significance (MGCS). His renal failure and thrombocytopenia did not improve with steroids or CyBorD, but he ultimately responded to rituximab, with resolution after four cycles.<br /><br />The report emphasizes that MGCS is an emerging entity in which monoclonal proteins cause clinically significant organ damage without meeting criteria for overt hematologic malignancy. Type 1 cryoglobulinemic vasculitis can present with nonspecific findings such as rash, neuropathy, cytopenias, and renal dysfunction. Diagnosis requires clinical suspicion, elevated cryoglobulins, and histologic evidence of vasculitis, along with a thorough evaluation to exclude myeloma, lymphoma, and MGUS. Treatment should target the underlying B-cell disorder and often requires a multidisciplinary approach.

Asset Subtitle

Joshua D. Garcia

Meta Tag

Author List Joshua D. Garcia, Noah Rice

Category Clinical Vignettes

Concept Monoclonal Gammopathy of Clinical Significance

Concept Type 1 Cryoglobulinemic Vasculitis

Concept Cryoglobulins

Concept Monoclonal Gammopathy

Concept Rituximab

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Joshua D. Garcia

Track Adult

Keywords

type 1 cryoglobulinemia

cryoglobulinemic vasculitis

monoclonal gammopathy of clinical significance

MGCS

acute kidney injury

renal failure

petechial rash

thrombocytopenia

rituximab

monoclonal IgG kappa

Monoclonal Gammopathy of Clinical Significance

Type 1 Cryoglobulinemic Vasculitis

Cryoglobulins

Monoclonal Gammopathy

Rituximab