B0621 - The Liver and Cryoglobulinemia: A Relationship Beyond Hepatitis C

Lakshmi P. Pappoppula, MD¹, Khalid Ahmed, MD¹, Abdul Ahad Ehsan Sheikh, MD¹, Beshir Saeed, MD¹, Roop Sunil Reddy, MD^2
1The Wright Center for GME, Scranton, PA; ²Geisinger Community Medical Center, Scranton, PA

Introduction: Cryoglobulinemia is a small and medium vessel vasculitis with varied clinical manifestations. The most common etiology is hepatitis C virus. Other hepatotropic viruses, including hepatitis A, have been rarely associated with very few cases reported. Here we present a unique case of cryoglobulinemia associated with hepatitis A.

Case Description/Methods: A 58-year-old female presented to the Emergency Department (ED) with bloating, abdominal pain, and fullness for about a week. She has a past medical history of diabetes mellitus type II, hypothyroidism, and hypertension. She was afebrile and hemodynamically stable in the ED with Initial lab workup showing AST/ALT of 5228/4792, total bilirubin of 7.9 with a direct bilirubin of 6.1. Further workup showed positivity for hepatitis A, including IgM and positive type II cryoglobulins. The rest of the autoimmune workup was negative for rheumatoid factor, ANA, SS/Ro, SS/La, anti-smooth muscle antibody, and anti-mitochondrial antibody. She also had acute renal failure requiring hemodialysis. Management included supportive therapy with significant improvement in her symptoms.

Discussion: Cryoglobulinemia is a condition where abnormal immunoglobulins precipitate in serum at temperatures below 37C. They can deposit in blood vessels and cause obstruction or vasculitis, with involvement of various organs. Type I cryoglobulinemia is usually associated with hematologic malignancies whereas mixed cryoglobulinemia (type II, III) is associated with hepatitis C and rarely seen with hepatitis A. Very few cases showing an interrelation between hepatitis A and cryoglobulinemia have been reported in the literature making this a rare association. Hence, more studies need to be done to investigate extrahepatic features of hepatitis A.


Disclosures:


Lakshmi P. Pappoppula, MD¹, Khalid Ahmed, MD¹, Abdul Ahad Ehsan Sheikh, MD¹, Beshir Saeed, MD¹, Roop Sunil Reddy, MD². B0621 - The Liver and Cryoglobulinemia: A Relationship Beyond Hepatitis C, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.