Hepatitis C Virus–Related Cryoglobulinemic Vasculitis

A 78-year-old woman with a history of chronic hepatitis C virus (HCV) infection presented to the hospital with a skin rash, diffuse arthralgias, and weakness. Physical examination showed a diffuse palpable purpuric rash (Figures A–C). Doppler examination showed an absence of perfusion, requiring amputation of the distal part of the fifth digit (Figure D). Serum protein electrophoresis and immunofixation showed the presence of an IgM κ monoclonal protein with markedly increased free κ chains. Cryoglobulin identification confirmed the presence of an IgM κ monoclonal spike and IgG polyclonal proteins, consistent with type II mixed cryoglobulinemia.

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