Myopericarditis in a Patient With Cryoglobulinemic Kidney Disease: A Case Report

Abstract

Cryoglobulinemic vasculitis is a rare small-vessel vasculitis leading to multi-organ dysfunction, often associated with chronic infections like hepatitis C virus (HCV), and autoimmune disorders. Most cases involve mixed monoclonal or polyclonal immunoglobulins, presenting symptoms such as purpura, arthralgias, and weakness. Severe organ involvement, particularly cardiac, is rare but potentially life-threatening. We report the case of a 48-year-old woman without prior medical history who presented with acute dyspnea, generalized petechial purpura, and signs of global heart failure. Imaging and laboratory findings indicated cardiomegaly, pericardial effusion, and significant nephrotic syndrome with renal failure. The diagnosis of cryoglobulinaemia was confirmed through histology and serology, showing monoclonal IgM with kappa hypergammaglobulinaemia and complement consumption. Treatment included various immunosuppressants, corticosteroids, and rituximab combined with renal replacement therapy. Following the initiation of treatment and proper management of heart failure, the patient's condition significantly improved. Cardiac involvement in cryoglobulinemic vasculitis, though rare, can lead to severe heart failure. This often involves necrotizing vasculitis of the coronary arteries or systemic inflammation damaging the cardiac muscle, as observed here. Cardiac manifestations with immunosuppressive therapy are reversible despite a poor long-term prognosis for patients with cardiac lesions. In conclusion, cryoglobulinemic vasculitis has a grim prognosis due to its multi-organ impact and the severity of the lesions. Early and aggressive treatment is essential to manage life-threatening acute presentations, even before confirming the diagnosis biologically or histologically.