Interest in cryoglobulins recently las increased because of the mounting suspicion that cryoglobulins may be symptomatic and even pathogenic in certain connective tissue diseases. It was once thought that cryoglobulins were homogeneous IgG or IgM globulins found in such disorders as multiple myeloma, Waldenstr枚m's macroglobulinemia, and proliferative lymphocytic diseases.1 Now, however, combinations of IgG-IgM or IgG-IgA are also known to occur as cryoglobulins and to account for nearly one third of all cases of cryoglobulinemia.2 An important feature of mixed cryoglobulins is their association with connective tissue diseases such as rheumatoid arthritis, Sj枚gren's syndrome, polyarteritis nodosa, etc, and a new syndrome described as "arthralgia-purpura -weakness -cryoglobulinemia."2
Patient Summary听
A 55-year-old white male store clerk had been in good health until he began having intermittent episodes of purpura, edema, and migratory joint swelling of his lower extremities about five years before admission. Urinalysis and hemogram during an attack