Cryoglobulinemia and liver involvement.

Liver involvement during essential mixed cryoglobulinemia (EMC) and cryoglobulins secondary to acute and chronic liver diseases has often been reported. Cryoglobulins in the serum seem to depend on an abnormal balance between their production and clearance. In this paper, 58 cases of mixed, mainly polyclonal cryoglobulinemia secondary to chronic liver diseases, and 23 cases of EMC, mainly monoclonal, are described. Amongst the EMC, 15 cases have been histologically followed-up and we have shown different types of related pathological liver involvement: from 'pathosis torbida' and chronic persistent hepatitis to chronic active hepatitis and liver cirrhosis. Only a few hepatic lymphoid infiltrates were nodular. According to our data and to those in the literature, we can suggest the following correlations between mixed cryoglobulinemic states and liver diseases: transient polyclonal cryoglobulins are secondary to acute viral liver diseases; polyclonal cryoglobulins are related to chronic liver diseases, initially produced by a polyclonal stimulation; mainly monoclonal, but also polyclonal cryoglobulins in which there is not always liver damage, but nodular infiltrates can be seen at the hepatic site; monoclonal, but also polyclonal cryoglobulins, in which there are nodular lymphoid infiltrates and vasculitis, as in immune complex diseases.