Type II cryoglobulinemic vasculitis in the setting of MALT lymphoma
The objectives of this article are to present a case of type II cryoglobulinemic vasculitis, explain why mucosa-associated lymphoid tissue (MALT) lymphoma is an unusual cause of type II cryoglobulins and to discuss the aetiology, epidemiology, pathophysiology and treatment of cryoglobulinemic vascul...
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| Veröffentlicht in: | BMJ case reports 2021-01, Vol.14 (1), p.e236267 |
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| description | The objectives of this article are to present a case of type II cryoglobulinemic vasculitis, explain why mucosa-associated lymphoid tissue (MALT) lymphoma is an unusual cause of type II cryoglobulins and to discuss the aetiology, epidemiology, pathophysiology and treatment of cryoglobulinemic vasculitis. A 67-year-old woman presented with 4 months of weight loss, intermittent epistaxis and a purpuric skin rash. Prior to presentation, she was found to have an elevated rheumatoid factor. Further investigation revealed an acute kidney injury and elevated type II cryoglobulins suspicious for cryoglobulinemic vasculitis, which was confirmed by kidney biopsy. Additional workup for the weight loss included biopsy of newly found splenomegaly. Pathology revealed MALT lymphoma, a rare cause of type II cryoglobulinemic vasculitis. Successful medical therapy required treating the underlying malignancy with rituximab and high-dose steroids. After initial resolution of symptoms with this regimen, the patient’s vasculitis worsened, which was thought to be secondary to undertreatment of the lymphoma. Bendamustine was added to further treat the lymphoma, after which the patient recovered and was able to discharge without recurrence of symptoms at 6 months. |
| doi_str_mv | 10.1136/bcr-2020-236267 |
| format | Article |
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A 67-year-old woman presented with 4 months of weight loss, intermittent epistaxis and a purpuric skin rash. Prior to presentation, she was found to have an elevated rheumatoid factor. Further investigation revealed an acute kidney injury and elevated type II cryoglobulins suspicious for cryoglobulinemic vasculitis, which was confirmed by kidney biopsy. Additional workup for the weight loss included biopsy of newly found splenomegaly. Pathology revealed MALT lymphoma, a rare cause of type II cryoglobulinemic vasculitis. Successful medical therapy required treating the underlying malignancy with rituximab and high-dose steroids. After initial resolution of symptoms with this regimen, the patient’s vasculitis worsened, which was thought to be secondary to undertreatment of the lymphoma. Bendamustine was added to further treat the lymphoma, after which the patient recovered and was able to discharge without recurrence of symptoms at 6 months.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2020-236267</identifier><identifier>PMID: 33436357</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Abdomen ; Acute Kidney Injury - etiology ; Adrenal Cortex Hormones - therapeutic use ; Aged ; Antibodies ; Antineoplastic Agents, Immunological - therapeutic use ; Bendamustine Hydrochloride - therapeutic use ; Biopsy ; Case Report ; Case reports ; Connective tissue diseases ; Creatinine ; Cryoglobulinemia - etiology ; Epistaxis ; Female ; Granulomas ; Hepatitis C ; Humans ; Immunoglobulins ; Immunotherapy ; Laboratories ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone - complications ; Lymphoma, B-Cell, Marginal Zone - drug therapy ; Medical imaging ; Microscopy ; Monoclonal antibodies ; Patients ; Peptides ; Proteins ; Purpura ; Rituximab - therapeutic use ; Splenomegaly - etiology ; Targeted cancer therapy ; Vasculitis - etiology</subject><ispartof>BMJ case reports, 2021-01, Vol.14 (1), p.e236267</ispartof><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b522t-f3eb0e0105bb0c4efac1909a1dd1d6f09c84e42cc3c49dc13e0e48f60d27e6d63</citedby><cites>FETCH-LOGICAL-b522t-f3eb0e0105bb0c4efac1909a1dd1d6f09c84e42cc3c49dc13e0e48f60d27e6d63</cites><orcidid>0000-0001-7708-2487 ; 0000-0002-6151-8845 ; 0000-0002-6287-2213</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805362/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805362/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33436357$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reed, Griffin J</creatorcontrib><creatorcontrib>Hazim, Antonious Z</creatorcontrib><creatorcontrib>Sanchez-Alvarez, Catalina</creatorcontrib><creatorcontrib>Warrington, Kenneth J</creatorcontrib><title>Type II cryoglobulinemic vasculitis in the setting of MALT lymphoma</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>The objectives of this article are to present a case of type II cryoglobulinemic vasculitis, explain why mucosa-associated lymphoid tissue (MALT) lymphoma is an unusual cause of type II cryoglobulins and to discuss the aetiology, epidemiology, pathophysiology and treatment of cryoglobulinemic vasculitis. A 67-year-old woman presented with 4 months of weight loss, intermittent epistaxis and a purpuric skin rash. Prior to presentation, she was found to have an elevated rheumatoid factor. Further investigation revealed an acute kidney injury and elevated type II cryoglobulins suspicious for cryoglobulinemic vasculitis, which was confirmed by kidney biopsy. Additional workup for the weight loss included biopsy of newly found splenomegaly. Pathology revealed MALT lymphoma, a rare cause of type II cryoglobulinemic vasculitis. Successful medical therapy required treating the underlying malignancy with rituximab and high-dose steroids. After initial resolution of symptoms with this regimen, the patient’s vasculitis worsened, which was thought to be secondary to undertreatment of the lymphoma. Bendamustine was added to further treat the lymphoma, after which the patient recovered and was able to discharge without recurrence of symptoms at 6 months.</description><subject>Abdomen</subject><subject>Acute Kidney Injury - etiology</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Aged</subject><subject>Antibodies</subject><subject>Antineoplastic Agents, Immunological - therapeutic use</subject><subject>Bendamustine Hydrochloride - therapeutic use</subject><subject>Biopsy</subject><subject>Case Report</subject><subject>Case reports</subject><subject>Connective tissue diseases</subject><subject>Creatinine</subject><subject>Cryoglobulinemia - etiology</subject><subject>Epistaxis</subject><subject>Female</subject><subject>Granulomas</subject><subject>Hepatitis C</subject><subject>Humans</subject><subject>Immunoglobulins</subject><subject>Immunotherapy</subject><subject>Laboratories</subject><subject>Lymphoma</subject><subject>Lymphoma, B-Cell, Marginal Zone - complications</subject><subject>Lymphoma, B-Cell, Marginal Zone - drug therapy</subject><subject>Medical imaging</subject><subject>Microscopy</subject><subject>Monoclonal antibodies</subject><subject>Patients</subject><subject>Peptides</subject><subject>Proteins</subject><subject>Purpura</subject><subject>Rituximab - therapeutic use</subject><subject>Splenomegaly - etiology</subject><subject>Targeted cancer therapy</subject><subject>Vasculitis - etiology</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkM1LwzAYh4MobsydvUnAm1CXrybtRRjDj8HEywRvoU3TraNtatIO-t-b0TnmyVzehDzv7315ALjF6BFjymepsgFBBAWEcsLFBRhjEYpAxOjr8uw-AlPndsgfilnE6DUYUcoop6EYg8W6bzRcLqGyvdmUJu3KotZVoeA-cco_2sLBoobtVkOn27aoN9Dk8H2-WsOyr5qtqZIbcJUnpdPTY52Az5fn9eItWH28LhfzVZCGhLRBTnWKNMIoTFOkmM4ThWMUJzjLcMZzFKuIaUaUoorFmcJUI82inKOMCM0zTifgachturTSmdJ1a5NSNraoEttLkxTy709dbOXG7KWIUOgV-YD7Y4A13512rdyZztZ-Z0mYEJgiRiNPzQZKWeOc1flpAkbyIF568fIgXg7ifcfd-WIn_lezBx4GIK12_6b9AAXejJ0</recordid><startdate>20210112</startdate><enddate>20210112</enddate><creator>Reed, Griffin J</creator><creator>Hazim, Antonious Z</creator><creator>Sanchez-Alvarez, Catalina</creator><creator>Warrington, Kenneth J</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7708-2487</orcidid><orcidid>https://orcid.org/0000-0002-6151-8845</orcidid><orcidid>https://orcid.org/0000-0002-6287-2213</orcidid></search><sort><creationdate>20210112</creationdate><title>Type II cryoglobulinemic vasculitis in the setting of MALT lymphoma</title><author>Reed, Griffin J ; 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A 67-year-old woman presented with 4 months of weight loss, intermittent epistaxis and a purpuric skin rash. Prior to presentation, she was found to have an elevated rheumatoid factor. Further investigation revealed an acute kidney injury and elevated type II cryoglobulins suspicious for cryoglobulinemic vasculitis, which was confirmed by kidney biopsy. Additional workup for the weight loss included biopsy of newly found splenomegaly. Pathology revealed MALT lymphoma, a rare cause of type II cryoglobulinemic vasculitis. Successful medical therapy required treating the underlying malignancy with rituximab and high-dose steroids. After initial resolution of symptoms with this regimen, the patient’s vasculitis worsened, which was thought to be secondary to undertreatment of the lymphoma. Bendamustine was added to further treat the lymphoma, after which the patient recovered and was able to discharge without recurrence of symptoms at 6 months.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>33436357</pmid><doi>10.1136/bcr-2020-236267</doi><orcidid>https://orcid.org/0000-0001-7708-2487</orcidid><orcidid>https://orcid.org/0000-0002-6151-8845</orcidid><orcidid>https://orcid.org/0000-0002-6287-2213</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Abdomen Acute Kidney Injury - etiology Adrenal Cortex Hormones - therapeutic use Aged Antibodies Antineoplastic Agents, Immunological - therapeutic use Bendamustine Hydrochloride - therapeutic use Biopsy Case Report Case reports Connective tissue diseases Creatinine Cryoglobulinemia - etiology Epistaxis Female Granulomas Hepatitis C Humans Immunoglobulins Immunotherapy Laboratories Lymphoma Lymphoma, B-Cell, Marginal Zone - complications Lymphoma, B-Cell, Marginal Zone - drug therapy Medical imaging Microscopy Monoclonal antibodies Patients Peptides Proteins Purpura Rituximab - therapeutic use Splenomegaly - etiology Targeted cancer therapy Vasculitis - etiology |
| title | Type II cryoglobulinemic vasculitis in the setting of MALT lymphoma |
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