CRYOGLOBULINEMIA: A CASE REPORT

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Abstract
A 50-year-old man noted severe aching pain in his fingers and hands which was aggravated by exposure to cold. Gangrene developed and the ends of 9 of the fingers and all of the toes were lost. Oscillometric readings in all extremities were normal. A cryoglobulin in concentration of 3 to 4 g% was demonstrated when serum was cooled to 34[degree]C or lower temperatures. Cooled to 8[degree]C, the precipitate assumed a crystalline form. Bone marrow contained 10-16% plasma cells, some atypical containing many cytoplasmic vacuoles. Sedimentation rate was enormously increased. Bence-Jones proteins were absent. Microfractionation of plasma (method No. 10 of Conn) showed 50.9% of a total protein of 9.2% to be in Fraction II. Electrophoresis Of the purified cryoglobulin showed a mobility of 2.6 x 10-5. The sedimentation constant of its major component was 7.6 x 10-13. N-terminal amino acids were found to be 2.00 moles of aspartic acid and 2.64 moles of glutamic acid/160,000 g protein. Bones showed evidence of demineralization without osteolytic lesions. Treatment with urethane and, later, adrenocortlcotropic hormone brought about no improvement. Patient died from meningitis secondary to otitis media. At autopsy, precipitation of protein with agglomeration of cells was found in all blood vessels. Abnormal plasma cells could not be demonstrated. There were no thromboses. Internal organs showed no evidence of former episodes of ischemia. The source of the abnormal cold precipitable protein remained in doubt.

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