NECROSIS OF PENILE AND EXREMITIES OF LIMBS DUE TO CRYOGLOBULINEMIC VASCULITIS WITH HEPATITIS C : A RARE CASE REPORT IN HEMODIALYZED PATIENT

Introduction:

Cryoglobulinemic vasculitisis an immune complex-mediated-inflammation of bloodvessels. Necrosis of penile with all limbs extremities are a rare complication. 

Methods:

We report one atypical case in hemodialyzed patient infected by Hepatitis C.

Results:

Figure 1. Acrocyanosis of lower limb

Figure 2. Necrosis of left upper limb

Figure 3. Necrosis of right upper limb

Figure 4. Necrosis of penile

A 49 years old male presented an acrocyanosis of limbs two weeks before his admission. He has a very high cardiovascularrisk factor with high blood pressure and diabetes, a medical background of syphilis and he is in end-stage chronic kidney disease due to an undetermined nephropathy . Physical examination revealed asthenia with weight loss, a rapidly extensive ulcerations and necrosis of penile, upper limbs and lower limbs. He has peripheral neuropathies and interstitial pneumopathy. Peripheral pulses were present. Ophtalmoscopic exam was normal. Investigations revealed a hemoglobin level of 9.8 g/dL and platelets of 146 G/l. Urinary protein quantification was 2.8 g/24 hours.   Skin biopsy was refused by the patient. Arterial and veinous ultrasounds of lower limbs were normal. HCV (Hepatitis C Viral) and HIV (Human Immunodeficiency Virus) serologies were respectively positive and negative. Cryoglobulinemy was positif with a rate cryoprecipitation in 1%, an  immunoglobulin G (Ig G) of 128 mg/l and immunoglobulin M (Ig M) of 320 mg/l. As treatment, he received in emergency corticosteroid bolus with antibiotic therapy to prevent skin infection. Plasmapheresis therapy was not available in Hospital. After one month of admission, the patient died due to a septic shock.

Conclusions:

In a low-income country, prevention is better than treating. Vaccination against viral infections should be systematically for all hemodialyzed patient.  

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.