case_images: PMC11284083_01
case_images: Clinical manifestations of cryoglobulinemic vasculitis in our patient. (A) Lower limbs palpable purpura. (B) Raynaud's phenomenon and purpuric rash.
case_images: fimmu-15-1385086-g001.jpg
case_images: PMC11284083_01_fimmu-15-1385086-g001.jpg
case_images: f1
case_images: A 57-year-old patient with a history of intravenous drug usage and chronic HCV infection presented asthenia, myalgia, back pain, and elbow arthralgia accompanied by a palpable purpura on the lower limbs and hands ( Figure 1A ) and a new Raynaud's phenomenon ( Figure 1B ).
case_images: (A) Cryoimmunofixation: on the left, serum migration and on the right, cryoprecipitate type III. (B) Relative serum cytokine levels analyzed using the Luminex Technique.
case_images: fimmu-15-1385086-g002.jpg
case_images: PMC11284083_01_fimmu-15-1385086-g002.jpg
case_images: f2
case_images: Serum cytokines analysis by Luminex revealed a marked elevation of IL-6 (540 pg/ml) without significant changes in other cytokines ( Figure 2B ).
case_images: Histology and direct immunofluorescence. (A, B) H&E staining of a skin biopsy of the purpuric lesion on the left lower limb revealing mixed perivascular and interstitial inflammatory infiltrate around the capillaries of the superficial and deep dermis, composed of altered neutrophils with some eosinophils. Note the leukocytoclasia with nuclear dust, frequent capillary thromboses, parietal alterations with endothelial clarification and vacuolisation, fibrinoid necrosis with intraluminal fibrin deposition, and vessel wall disruption with red cell extravasation in the superficial, middle and deep dermis. (C) Direct immunofluorescence with deposits of IgM, IgG, IgA and C3 along the dermoepidermal junction and the superficial vasculature.
case_images: fimmu-15-1385086-g003.jpg
case_images: PMC11284083_01_fimmu-15-1385086-g003.jpg
case_images: f3
case_images: We observed leukocytoclasia with nuclear dust, frequent capillary thromboses, parietal alterations with endothelial clarification and vacuolisation, fibrinoid necrosis, and vessel wall disruption with red cell extravasation ( Figures 3A, B ). Direct immunofluorescence showed IgM, IgG, IgA and C3 deposits along the dermoepidermal junction and in the vessel walls of the superficial skin vasculature ( Figure 3C ).