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Non-organ Specific Antibodies and Suspected Cryoglobulinemia: a Diagnostic Challenge

Norbert Shtaynberg, Majed Samarneh, Abdallah Geara, Edward Epstein, Suzanne El-Sayegh

Abstract


Interpreting the significance of non-organ-specific auto-antibodies is clinically challenging. A 58-year-old Egyptian immigrant woman presented with cutaneous bullous lesions and acute renal failure. She was suffering from hepatitis C infection and vasculitis with arterial and arteriolar intraluminal eosinophilic material, potentially representing cryoglobulin aggregate, as well as inflammatory infiltrates within the vessel walls. Her hospital course was complicated by an acalculous cholecystitis. The auto-antibody profile was positive for anti-proteinase-3, myeloperoxidase, cardiolipin IgG and phospholipid IgG. The presence of non-organ-specific antibodies was reported at a high frequency in cryoglobulinemia associated with hepatitis C genotype 4; this association is uncommon in the United States but prevalent in Egypt.

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