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Hindi Case Report
Cyroglobulinemia in Chronic Hepatitis B Infection with Undetectable Viral Load
Adham M. Osman1*, Stacey Honda1, Karen Ching1 and Michael Sharrak2
1Kaiser Permanente, Hawaii Residency Program, Internal Medicine, Honolulu, Hawaii, USA
2University of Medicine and Health Sciences, Federation of Saint Kitts and Nevis
- *Corresponding Author:
- Adham Osman
Kaiser Permanente, Hawaii Residency Program
Internal Medicine, Honolulu, Hawaii, USA
Tel: (808)-425-2540
E-mail: Adham.M.Osman@kp.org
Received date: July 28, 2017; Accepted date: August 16, 2017; Published date: August 21, 2017
Citation: Osman MA, Honda S, Ching K, Sharrak M (2017) Cyroglobulinemia in Chronic Hepatitis B Infection with Undetectable Viral Load. J Clin Infect Dis Pract 2:119. doi:10.4172/2476-213X.1000119
Copyright: © 2017 Osman AM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
A 53 year old woman with history of chronic hepatitis B presents with palpable purpura of the lower extremities and recurrent hematuria. She was found to have elevated creatinine (1.4 mg/dl increased from her baseline of 0.8 mg/dl) and proteinuria (6.8 mg/dl). Renal biopsy revealed membranoproliferative glomerulonephritis and epidermal biopsy revealed leukocytoclastic vasculitis. Serum cryoglobulin precipitate was positive and Hepatitis B viral load was initially undetectable as the sample was allowed to cool to room temperature. A repeat sample was retested while keeping the serum above 37°C, this time the viral load was found to be elevated at 361 copies/ml. Both antiviral (entecavir) and immunosuppressive therapy (cyclophosphamide and prednisone) were initiated and the patient’s skin and renal manifestations improved rapidly. Proper communication between the clinician and laboratory is essential to ensure an accurate diagnosis in the context of cryoglobulinemic vasculitis.
