Cryoglobulinemia is a disease mediated by
antibodies with the property to precipitate at temperatures below 37°C. It can be distinguished into a primitive form (also referred to as 'essential mixed
cryoglobulinemia'), and a secondary form. In the essential mixed variant a key role is played by HCV
infection. The pathogenesis of mixed
cryoglobulinemia is mediated by
immune complexes that are the most important cause of the vasculitic phenomena, typical of the disease. However, the severity of the clinical manifestations is not always related to the serum levels of
cryoglobulins and
immune complexes. In our case report, a 46-year old man came to our observation with asymmetric diffuse and invalidating arthralgies, with both substitutive and additive behaviour, located at pelvic girdle, inferior limbs and elbows, associated to skin lesion vascultis-like. The remote pathological anamnesis was characterized by a previous surgically treated
non-Hodgkin lymphoma, and HCV
infection. Despite several attempts were done, it was not possible to reveal
cryoglobulins, nor reumatoid factor in the serum.
Cryoglobulins resulted positive only after the third day of hospitalization, along with a new
fever attack and a worsening of the vasculitic manifestations. In conclusion, this case demonstrated that
cryoglobulinemia can occur with a totally atypical sequence of clinical manifestations which can be present before and in absence of the typical laboratory proofs.