A Case of Cryoglobulinemia-induced Acute Respiratory Distress Syndrome.

Kim, Byung Gyu; Shim, Jae Jeong; Jung, Ki Hwan; Shin, Jeong Ho; Lee, Seung Heon; Kong, Hee Sang; Kim, Je Hyeong; Bak, Sang Myeon; Shin, Chol; In, Kwang Ho; Kang, Kyung Ho; Yoo, Se Hwa

doi:2001.51.2.155

Tuberc Respir Dis > Volume 51(2); 2001 > Article

Case Report

Tuberculosis and Respiratory Diseases 2001;51(2):155-160.
DOI: https://doi.org/10.4046/trd.2001.51.2.155 Published online August 1, 2001.

A Case of Cryoglobulinemia-induced Acute Respiratory Distress Syndrome.

Byung Gyu Kim, Jae Jeong Shim, Ki Hwan Jung, Jeong Ho Shin, Seung Heon Lee, Hee Sang Kong, Je Hyeong Kim, Sang Myeon Bak, Chol Shin, Kwang Ho In, Kyung Ho Kang, Se Hwa Yoo

Abstract

Cryoglobulinemia is the presence of globulins in the serum that precipitate on exposure to cold temperatures (cryoglobulins). Pulmonary complications of cryoglobulinemia include interstial infiltration, impaired gas exchange, small airway disease and pleurisy. Only one other acute respiratory distress syndrome(ARDS) case has been described in patients with cryoglobulinemia. A 55-years old man was admitted with dyspnea. He had been diagnosed as being a hepatitis B virus antigen carrier 15 years age. On the first admission, chest radiography showed a bilateral pleural effusion and a patchy infiltration on both lungs. On protein-and immuno-electrophoresis, cryoglobulinemia was confirmed. The patient was treated with corticosteroid and plasmapheresis. Forty-five days after the diagnosis, the patient complained of progressive dyspnea and showed a diffuse bilateral pulmonary infiltration on chest radiography. Despite intensive care with mechanical ventilation, the patient died as consequence of hypoxemia and multiple systemic organ failure. On a pathologic examination of the postmortem lung biopsy, multiple necrotizing vasculitis and increased infiltration of the lymphocytes and monocytes were observed. In conclusion, ARDS developed as a result of pulmonary hemorrhage due to cryoglobulinemia-associated vasculitis.

Key Words: Cryoglobulinemia, Acute respiratory distress syndrome