Clin Nephrol. 2024 Oct;102(4):244-247. doi: 10.5414/CN111383.
Mixed cryoglobulinemia is a small vessel vasculitis associated with viral infections, mainly hepatitis C virus, however, other important causes include lymphoproliferative and autoimmune disorders. Influenza vaccine-induced cryoglobulinemia has been rarely reported. A 68-year-old male presented on three occasions following influenza vaccination with purpuric rash and lower extremities swelling. His lab work showed mixed cryoglobulins. On his most recent presentation, in addition to the purpura, he presented with thrombocytopenia and nephritic syndrome. A kidney biopsy showed endocapillary proliferative glomerulonephritis with organized deposits, consistent with mixed type cryoglobulinemic glomerulonephritis. The patient was treated with rituximab infusion with progressive improvement of the acute kidney injury (AKI) and complete recovery. It is unclear why cryoglobulins are produced as a response to a vaccination, but this association is important to be aware of for prompt monitoring and treatment.
混合性冷球蛋白血症是一种与病毒感染相关的小血管血管炎，主要与丙型肝炎病毒有关，但其他重要病因包括淋巴增生性和自身免疫性疾病。流感疫苗诱导的冷球蛋白血症很少见。一名 68 岁男性在接种流感疫苗后出现了三次紫癜性皮疹和下肢肿胀。他的实验室检查显示混合性冷球蛋白血症。在最近一次就诊时，除了紫癜外，他还出现了血小板减少和肾病综合征。肾脏活检显示伴有组织沉积的内皮下增生性肾小球肾炎，符合混合性冷球蛋白血症性肾小球肾炎。该患者接受了利妥昔单抗输注治疗，急性肾损伤（AKI）逐渐改善，完全恢复。目前尚不清楚为什么冷球蛋白会作为疫苗接种的反应产生，但这种关联很重要，需要及时监测和治疗。
