Cryoglobulinaemic vasculitis secondary to mantle cell lymphoma presenting with necrosis of fingers
Abstract
We report a case of a male patient with mantle cell lymphoma (MCL) with secondary cryoglobulinaemic vasculitis without monoclonal protein. MCL was diagnosed during the diagnostics of necrosis of fingers, the first symptom of the underlying disease. The diagnosis was made after excluding other causes of cryoglobulinaemia, including infectious and autoimmune causes. The progression of necrosis was inhibited after the initiation of MCL treatment (rituximab, glucocorticoids) and symptomatic treatment (vasodilators).
This article describes the first MCL case associated with extensive necrosis of the fingers. Cryoglobulinaemic vasculitis without monoclonal protein due to malignancy is rare. An oncological aetiology must also be considered during the differential diagnosis of the causes of vasculitis, even if cancer symptoms are absent.
Keywords: cryoglobulinaemic vasculitiscryoglobuilinaemianecrosismantle cell lymphoma
References
- Takada S, Shimizu T, Hadano Y, et al. Cryoglobulinemia (review). Mol Med Rep. 2012; 6(1): 3–8.
- Kur-Zalewska J. Cryoglobulinaemic vasculitis. Reumatologia/Rheumatology Supplements. 2016: 65–67.
- Terrier B, Cacoub P. Cryoglobulinemia vasculitis: an update. Curr Opin Rheumatol. 2013; 25(1): 10–18.
- De Vita S, Soldano F, Isola M, et al. Preliminary classification criteria for the cryoglobulinaemic vasculitis. Ann Rheum Dis. 2011; 70(7): 1183–1190.
- Pei S, Chen Ch, Lin S, et al. Mantle Cell Lymphoma Presented as Cryoglobulinemic Vasculitis. J Cancer Res Pract. 2020; 7(1): 41–44.
- Andeen NK, Abdulameer S, Charu V, et al. A Diverse Spectrum of Immune Complex- and Complement-Mediated Kidney Diseases Is Associated With Mantle Cell Lymphoma. Kidney Int Rep. 2022; 7(3): 568–579.
- Kyle RA, Ansell SM, Kapoor P. Prognostic factors and indications for treatment of Waldenström's Macroglobulinemia. Best Pract Res Clin Haematol. 2016; 29(2): 179–186.
- Arora S, Levitan D, Regmi N, et al. Cryoglobulinemia in a patient with chronic lymphocytic leukemia - A case report and review of literature of renal involvement in CLL. Blood Cells Mol Dis. 2016; 60: 7–11.
- Muchtar E, Magen H, Gertz MA. How I treat cryoglobulinemia. Blood. 2017; 129(3): 289–298.
- Miyata KN, Siddiqi NA, Kiss LP, et al. Antineutrophil cytoplasmic antibody-positive pauci-immune glomerulonephritis associated with mantle cell lymphoma. Clin Nephrol Case Stud. 2017; 5: 9–15.
- Mhedhbi B, Chargui S, Harzallah A, et al. Proliferative glomerulonephritis and mantle cell lymphoma: a rare association. BMJ Case Rep. 2021; 14(2).
- Kyle RA, Ansell SM, Kapoor P. Prognostic factors and indications for treatment of Waldenström's Macroglobulinemia. Best Pract Res Clin Haematol. 2016; 29(2): 179–186.
- Arora S, Levitan D, Regmi N, et al. Cryoglobulinemia in a patient with chronic lymphocytic leukemia - A case report and review of literature of renal involvement in CLL. Blood Cells Mol Dis. 2016; 60: 7–11.
- Gobbi PG, Bettini R, Montecucco C, et al. Study of prognosis in Waldenström's macroglobulinemia: a proposal for a simple binary classification with clinical and investigational utility. Blood. 1994; 83(10): 2939–2945.
- Terrier B, Cacoub P. Cryoglobulinemia vasculitis: an update. Curr Opin Rheumatol. 2013; 25(1): 10–18.
- Mukhtyar C, Guillevin L, Cid MC, et al. European Vasculitis Study Group. EULAR recommendations for the management of primary small and medium vessel vasculitis. Ann Rheum Dis. 2009; 68(3): 310–317.
- Liu XH, Liu MX, Jin F, et al. Concomitant cryoglobulinemic vasculitis and cold agglutinin disease successfully treated with bortezomib: A case report. Medicine (Baltimore). 2019; 98(4): e14201.