SHM Converge Scientific Abstract ePoster Gallery-Pulmonary Renal Syndrome as a Manifestation of Type I Cryoglobulinemic Vasculitis

Pdf Summary

This case report describes a rare instance of pulmonary-renal syndrome (PRS) caused by type I cryoglobulinemic vasculitis in a 66-year-old man with recurrent multiple myeloma. PRS is a life-threatening condition marked by diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis, most often linked to ANCA-associated vasculitis, anti-GBM disease, or immune complex disorders. It is uncommon in cryoglobulinemic vasculitis and is more typically associated with mixed types II and III than type I.<br /><br />The patient presented with weeks of fatigue, shortness of breath, bleeding symptoms, epistaxis, and hemoptysis. Initial findings included acute kidney injury, anemia, thrombocytopenia, low C4, proteinuria, and microscopic hematuria. Imaging showed multifocal ground-glass opacities, and he was initially treated for pneumonia and presumed dehydration-related AKI. However, worsening hypoxia and the combination of hemoptysis and renal dysfunction raised concern for PRS.<br /><br />Further evaluation revealed a positive cryoglobulin test, monoclonal IgG kappa on immunofixation, abnormal protein studies, and bone marrow biopsy confirming recurrence of multiple myeloma. He was diagnosed with PRS secondary to type I cryoglobulinemic vasculitis in the setting of relapsed multiple myeloma.<br /><br />Treatment with high-dose corticosteroids, plasmapheresis, and rituximab led to clinical improvement. The report emphasizes that PRS can be easily mistaken for pneumonia or other causes of AKI, making early recognition critical. It also highlights the importance of considering cryoglobulinemic vasculitis, especially type I, in patients with hematologic malignancies such as multiple myeloma. Multidisciplinary management and prompt immunosuppressive therapy are essential to improving outcomes.

Asset Subtitle

Katarzyna M. Purzycka

Meta Tag

Author List Hawraa Alsaedi MS-III, Jeremy J. Gentile, Katarzyna M. Purzycka

Category Clinical Vignettes

Concept Pulmonary-Renal Syndrome

Concept Diffuse Alveolar Hemorrhage

Concept Rapidly Progressive Glomerulonephritis

Concept ANCA-Associated Vasculitis

Concept Anti-GBM Disease

Distinguished Non-Finalist

Presenter Organization Corewell Health West

Presenting Author Katarzyna M. Purzycka

Track Adult

Keywords

pulmonary-renal syndrome

type I cryoglobulinemic vasculitis

multiple myeloma

diffuse alveolar hemorrhage

rapidly progressive glomerulonephritis

cryoglobulinemia

hemoptysis

acute kidney injury

rituximab

plasmapheresis

Pulmonary-Renal Syndrome

Diffuse Alveolar Hemorrhage

Rapidly Progressive Glomerulonephritis

ANCA-Associated Vasculitis

Anti-GBM Disease