Emergency in cryoglobulinemia: Clinical and therapeutic approach

Abstract

Cryoglobulinemia can sometimes manifest as an emergency. Often times, the emergency cannot be controlled and evolution is fatal, especially when the kidney, gut, lung, and central nervous system are involved. The best therapeutic strategy for life-threatening cryglobulinemia remains to be defined. Initial therapy may consist of a combination of corticosteroids, immunosuppressive agents, and plasma exchange. In HCV patients, the addition of combined antiviral treatment is indicated but, since the response to these drugs is generally slow, corticosteroids combined with cytotoxic agents are often initially useful in the control of life-threatening organ involvement. Recently, data on the efficacy of rituximab have been reported, showing that the antibody is very efficacious against the production of cryoglobulins and their clinical consequences. Most important, however, is that in emergencies therapeutic procedures should be started as soon as possible.