Published online Mar 16, 2016. doi: 10.12998/wjcc.v4.i3.81
Peer-review started: August 10, 2015
First decision: October 14, 2015
Revised: November 4, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: March 16, 2016
Processing time: 216 Days and 13.7 Hours
A 60-year-old male patient presented with jaundice and dark urine for three days, icteric sclerae and skin rash on his legs for six months. Laboratory investigations revealed an atypical cryoglobulinemia with high hepatitis C virus (HCV)-RNA levels. Imaging studies showed cholestasis was accompanying HCV. Capillary zone electrophoresis using immunosubtraction method revealed a polyclonal immunoglobulin G and immunoglobulin A (IgA) monoclonal cryoglobulin and that IgA lambda was absent in immunofixation electrophoresis. After a liver biopsy, chronic hepatitis C, HCV related mixed cryoglobulinemia and cryoglobulinemic vasculitis were diagnosed and antiviral therapy was initiated. Our HCV patient presented with cryoglobulinemic symptoms with an atypical cryoglobulinemia that was detected by an alternative method: Immunosubtraction by capillary electrophoresis. Different types of cryoglobulins may therefore have a correlation with clinical symptoms and prognosis. Therefore, the accurate immunotyping of cryoglobulins with alternative methods may provide more information about cryoglobulin-generated pathology.
Core tip: We describe atypical IgA monoclonal cryoglobulinemia as the presenting symptom of chronic hepatitis C. Immunotyping of the cryoglobulin was performed with capillary zone electrophoresis with immunosubtraction method which is an alternative method to classical immunofixation electrophoresis. Accurate immunotyping of cryoglobulins with alternative method provide more information about cryoglobulin-generated pathology in atypical patients.