Cryoglobulinemia presenting as "factitial ulceration"

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Abstract
A case of "essential" cryoglobulinemia was initially misdiagnosed as factitial ulceration. The abnormal protein, not demonstrable on routine electrophoresis, was characterized as a macrocryoglobulin. A biologic false-positive reaction occurred with the venereal disease research laboratory test for syphilis (VDRL), and the Kolmer and fluorescent treponemal antibody (FTA-200) tests, but the Reiter protein complement fixation test (RPCF), fluorescent treponemal antibody test with serum absorbed by Reiter protein sonicate (FTA-abs), and Trepo-nema pallidum immobilization test (TPI) were nonreactive. Pitfalls in diagnosis of cryoglobulinemia are enumerated. Clinical criteria for factitial ulceration are applied.

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