Gao Yunyi, Chen Dawei, Li Yan, Chen Huijiao, Ran Xingwu
Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
J Inflamm Res. 2021 Apr 28;14:1661-1666. doi: 10.2147/JIR.S308687. eCollection 2021.
We presented a case of hepatitis B virus (HBV)-related type III cryoglobulinemia vasculitis (CryoVas) characterized by extremity gangrene in a patient with diabetes. The 60-year-old female had a 10-year history of poorly controlled type 2 diabetes mellitus. She complained of sudden onset pain and swelling of toes which quickly progressed to gangrene, with fingers becoming pain and dark violet. The patient was initially misdiagnosed as diabetic foot (DF). Although DF is one of the common chronic complications of diabetes, it rarely involves the hand. What is more, the ischemic manifestations of the extremity were not consistent with the results of the vascular examination and immune system changes. The patient had Raynaud's phenomenon, arthralgia, and extremity gangrene. Test results showed cryoglobulinemia multiple positive, polyclonal immunoglobulin with rheumatoid factor negative, lower complement 3, leukocytoclastic vasculitis, and HBV infection. HBV-related type III CryoVas was finally diagnosed, and a conservative therapy strategy was given. Six months after treatment with cyclophosphamide, corticosteroid, nucleoside/nucleotide analog therapy, local debridement, and dressing change, she recovered and kept no recurrence by following up for 30 months. To our knowledge, this is the first report of extremity gangrene caused by HBV-related CryoVas in a diabetic patient.
我们报告了一例乙型肝炎病毒（HBV）相关的III型冷球蛋白血症血管炎（CryoVas），其特征为一名糖尿病患者出现肢体坏疽。这位60岁女性有10年控制不佳的2型糖尿病病史。她主诉脚趾突然疼痛肿胀，很快发展为坏疽，手指也出现疼痛和暗紫色。该患者最初被误诊为糖尿病足（DF）。虽然DF是糖尿病常见的慢性并发症之一，但很少累及手部。此外，肢体的缺血表现与血管检查结果和免疫系统变化不一致。该患者有雷诺现象、关节痛和肢体坏疽。检查结果显示冷球蛋白血症多次阳性、类风湿因子阴性的多克隆免疫球蛋白、补体3降低、白细胞破碎性血管炎以及HBV感染。最终诊断为HBV相关的III型CryoVas，并给予了保守治疗策略。在接受环磷酰胺、皮质类固醇、核苷/核苷酸类似物治疗、局部清创和换药治疗6个月后，她康复了，随访30个月无复发。据我们所知，这是第一例关于糖尿病患者中由HBV相关的CryoVas导致肢体坏疽的报告。
