Severe cutaneous vasculitis following intravenous infusion of gammaglobulin in a patient with type II mixed cryoglobulinemia

M. Yebra¹, Y. Barrios², J. Rincón¹, I. Sanjuan³, F. Díaz-Espada²

Departments of Internal Medicine1, Immunology2, and Haematology3, Hospital Clínica Puerta de Hierro, Madrid, Spain. 

ABSTRACT
Intravenous infusion of gammaglobulins (IVIG) is one of the treatments of choice in patients with type II mixed cryoglobulinemia (MC). We describe the case of a patient with MC who suffered an adverse generalised reaction with severe cutaneous vasculitis accompanied by a sudden increase in cryocrit levels shortly after being treated with IVIG. When the same gammaglobulin preparation was added in vitro to a sample of the patientÕs serum, a strong increment in cryoglobulin precipitation and depletion of the monoclonal IgM peak resulted. We suggest that this simple method of studying the displacement of the precipitation reaction could help to predict the outcome of treatment and must be performed before starting IVIG in patients with MC.

Key words
Intravenous immunoglobulins, cryoglobulins.

Please address correspondence and reprint requests to: Dr. Fernando Díaz-Espada, Department of Immunology, Hospital Clínica Puerta de Hierro, San Martín de Porres 4, 28035 Madrid, Spain. 
E-mail: fdiaz@ hpth.insalud.es

Clin Exp Rheumatol 2002; 20: 225-227.
© Copyright Clinical and Experimental Rheumatology 2002.