Vol 3, No 1 (2017)
Case report
Published online: 2017-04-19
Cryoglobulinemia in the course of a primary Sjögren’s syndrome
Forum Reumatol 2017;3(1):35-38.
Abstract
A 58-year-old woman with primary Sjögren’s syndrome (pSS), peripheral neuropathy and positive serum cryoglobulin was admitted for evaluation of purpura on her skin. Cryoglobulinemic vasculitis was diagnosed based on clinical and laboratory findings . There was no response to cyclophosphamide pulse therapy, steroid therapy and cyclosporine. We presente the discussion about cryoglobulinemic vasculitis in pSS, the overall prognosis (B-cell lymphomas) and differential diagnosis.
Keywords: primary Sjögren’s syndromecryoglobulinspurpuralymphomas
References
- Jennette J, Falk R. Small-Vessel Vasculitis. N Engl J Med. 1997; 337(21): 1512–1523.
- Ramos-Casals M, Anaya JM, García-Carrasco M, et al. Cutaneous vasculitis in primary Sjögren syndrome: classification and clinical significance of 52 patients. Medicine (Baltimore). 2004; 83(2): 96–106.
- Ferri C. Mixed cryoglobulinemia. Orphanet J Rare Dis. 2008; 3: 25.
- Dwilewicz-Trojaczek J. Krioglobulinemia. In: Wardyn K, Życińska K. ed. Pierwotne układowe zapalenia naczyń. Urban&Partne, Wrocław 2004: 295–309.
- Retamozo S, Gheitasi H, Quartuccio L, et al. Cryoglobulinaemic vasculitis at diagnosis predicts mortality in primary Sjögren syndrome: analysis of 515 patients. Rheumatology (Oxford). 2016; 55(8): 1443–1451.
- Strunk J, Taborski U, Neeck G. Essential cryoglobulinemic vasculitis with severe peripheral neuropathy and neurogenic muscular atrophy - inducing remission by cascade filtration. Z Rheumatol. 2002; 61(6): 733–739.
- Brito-Zerón P, Ramos-Casals M, Bove A, et al. Predicting adverse outcomes in primary Sjogren's syndrome: identification of prognostic factors. Rheumatology (Oxford). 2007; 46(8): 1359–1362.
- Martel C, Gondran G, Launay D, et al. Active immunological profile is associated with systemic Sjögren's syndrome. J Clin Immunol. 2011; 31(5): 840–847.
- Quartuccio L, Isola M, Baldini C, et al. Biomarkers of lymphoma in Sjögren's syndrome and evaluation of the lymphoma risk in prelymphomatous conditions: results of a multicenter study. J Autoimmun. 2014; 51: 75–80.
- Risselada AP, Kruize AA, Bijlsma JWJ. Clinical features distinguishing lymphoma development in primary Sjögren's Syndrome--a retrospective cohort study. Semin Arthritis Rheum. 2013; 43(2): 171–177.
- Johnsen SJ, Brun JG, Gøransson LG, et al. Risk of non-Hodgkin's lymphoma in primary Sjögren's syndrome: a population-based study. Arthritis Care Res (Hoboken). 2013; 65(5): 816–821.
- Rischmueller M, Tieu J, Lester S. Primary Sjögren's syndrome. Best Pract Res Clin Rheumatol. 2016; 30(1): 189–220.
- Vitali C. Immunopathologic differences of Sjögren's syndrome versus sicca syndrome in HCV and HIV infection. Arthritis Res Ther. 2011; 13(4): 233.
- Seror R, Bowman SJ, Brito-Zeron P, et al. EULAR Sjögren's syndrome disease activity index (ESSDAI): a user guide. RMD Open. 2015; 1(1): e000022.
- Seror R, Bootsma H, Saraux A, et al. EULAR Sjögren's Task Force. Defining disease activity states and clinically meaningful improvement in primary Sjögren's syndrome with EULAR primary Sjögren's syndrome disease activity (ESSDAI) and patient-reported indexes (ESSPRI). Ann Rheum Dis. 2016; 75(2): 382–389.
- Baldini C, Pepe P, Quartuccio L, et al. Primary Sjogren's syndrome as a multi-organ disease: impact of the serological profile on the clinical presentation of the disease in a large cohort of Italian patients. Rheumatology (Oxford). 2014; 53(5): 839–844.
- Quartuccio L, Isola M, Baldini C, et al. Clinical and biological differences between cryoglobulinaemic and hypergammaglobulinaemic purpura in primary Sjögren's syndrome: results of a large multicentre study. Scand J Rheumatol. 2015; 44(1): 36–41.
- Ahmed MS, Wong CF. Should rituximab be the rescue therapy for refractory mixed cryoglobulinemia associated with hepatitis C? J Nephrol. 2007; 20(3): 350–356.
- Roccatello D, Baldovino S, Rossi D, et al. Rituximab as a therapeutic tool in severe mixed cryoglobulinemia. Clin Rev Allergy Immunol. 2008; 34(1): 111–117.