Type III mixed cryoglobulinaemia in the course of Hantavirus nephropathy.

Abstract

Mixed cryoglobulins are encountered in the acute were: serum creatinine concentration, 325 mmol/litre; platelet count 400 000/mm3. Urine and blood cultures phase of some viral illnesses. Hantavirus nephropathy (HN) is a serious illness due to Hantaviruses [1]. To remained sterile. Renal ultrasonography was normal. An IgM-IgA-IgG mixed cryoglobulin was found positour knowledge, mixed cryoglobulinaemia has never been reported in the course of HN. We report here ive (IgG, 1.7 mg/litre; IgA, 3.6 mg/litre; IgM, 6.8 mg/litre). Usual causes of mixed cryoglobulinaemia four cases of mixed cryoglobulins associated with HN. were negative (HCV, CMV, EBV, HIV, HBV ). Hantaan virus serology was positive ( IgM 15512) and Case reports significantly increased 2 weeks later (IgM 151024). The patient promptly recovered and was discharged on the 7th day. Cryoglobulin was undetectable 6 Case report 1 months later (see Table 1). A 37-year-old man was admitted on March 1996 to our unit because of fever and acute renal failure. Case 3 Physical examination was normal. Laboratory investigations showed: white blood cell count, 8600/mm3; A 39-year-old man was admitted to our unit in June platelet count, 129 000/mm3; serum creatinine, 1996 because of fever and loin pain. Clinical examina767 mmol/litre. Blood and urine cultures were negative. tion was without particularity. Significant laboratory Ultrasound examination was normal. One day after data were: serum creatinine level, 957 mmol/litre; plateadmission, petechial purpura appeared in the lower let count, 80 000/mm3. Urine and blood cultures were limbs. Cutaneous biopsy revealed a leukocytoclasic negative. Hantaan virus serology was positive (IgM vasculitis. An IgM-IgA-IgG type III cryoglobulinaemia 15256) and significantly increased 2 weeks later (IgM was found positive (IgG, 33 mg/litre; IgA, 68 mg/litre; 15512). An IgM–IgG mixed cryoglobulin was found IgM, 135 mg/litre). Serologic tests for hepatitis C virus positive ( IgG, 48 mg/litre; IgM, 67 mg/litre). Usual (HCV ), hepatitis B virus (HBV ), Epstein–Barr virus causes of mixed cryoglobulinaemia were negative (EBV ), cytomegalovirus (CMV ) and human immuno(HCV, CMV, EBV, HIV, HBV ). Renal function deficiency virus (HIV ) were negative. HCV polymerase promptly improved and the patient was discharged on chain reaction (PCR) was negative. Purpura promptly day 10. Four months later, cryoglobulin was undetectdisappeared with clinostatism. Hantaan virus serology able whereas IgG against Puumala virus was positive was positive (IgM 15256) and significantly increased (1/120) (see Table 1). 2 weeks later (IgM 151024). Renal function improved without requiring haemodialysis and the patient was Case 4 discharged on the 10th day. Six months later, cryoglobulinaemia was not detectable any more and IgG against A 44-year-old man was hospitalized in June 1996 Puumala virus were positive by ELISA method (1/60) because of fever and acute renal failure. Clinical exam(see Table 1). ination was normal. Laboratory data showed: serum creatinine concentration, 766 mmol/litre; platelet count, 39 000/mm3. Both blood and urine cultures were negaCase report 2 tive. Histologic examination of kidney biopsy revealed A 56-year-old man was admitted to our unit on April acute interstitial nephritis. Ten glomeruli were examin1996 because of fever and acute renal failure. Physical able and all were normal. Hantaan virus serology was examination was normal. Significant laboratory data positive (IgM 15256) and significantly increased 2 weeks later (IgM 151024). An IgM–IgG mixed cryoglobulin was found positive (IgG, 87 mg/litre; IgM, Correspondence and o print requests to: Dr Didier Ducloux, Service de Nephrologie, Hopital St Jacques, 25000 Besancon, France. 112 mg/litre). Usual causes of mixed cryoglobulinae-