HCV Induced Cryoglobulinemic Vasculitis - Diagnostic Difficulties in Suburban India - A Case Based Review

While HCV vasculitis with mild symptoms is a fairly common presentation, cryoglobulinemia with renal impairment causing the death of a patient is not a very commonly encountered scenario in everyday clinical practice. Here we present an engrossing case of an elderly woman who was referred with bilateral lower limb swelling, acute renal impairment secondary to suspicious sepsis with no response to multiple antibiotics. There were also complaints of arthralgias and severe neuropathic pain. Routine screening for viral markers came out positive for HCV. Examination findings of purpura and Raynaud's phenomenon lead to clinical suspicion of cryoglobulinemic vasculitis. Serum complement levels were decreased, Anti- Nuclear Antibodies came back positive along with Rheumatoid factor. While awaiting the biochemical confirmation of cryoglobulins, the patient deteriorated even after starting on high dose steroids. We lost the patient during the course of treatment due to renal failure, poor general condition, and late presentation to the hospital.