Cryoglobulinemia physical examination: Difference between revisions

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==Overview==
==Overview==
Physical examination of patients with cryoglobulinemia is usually remarkable for: purpura, arthralgia, and acrocyanosis.  Type I cryoglobulinemia predominantly affects the kidney, skin and bone marrow whereas mixed CG (types II and III) predominantly involves the skin and peripheral nervous system. The various signs that appear are most commonly due to underlying hyperviscosity and thrombosis.


==Physical Examination==
==Physical Examination==
 
Physical examination of patients with cryoglobulinemia is usually remarkable for: purpura, arthralgia, and acrocyanosis.  Type I cryoglobulinemia predominantly affects the kidney, skin and bone marrow whereas mixed CG (types II and III) predominantly involves the skin and peripheral nervous system.
*Physical examination of patients with cryoglobulinemia is usually remarkable for: purpura, arthralgia, and acrocyanosis.  


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with cryoglobulinemia usually appear normal. Clinical manifestations that appear vary according to the type of cryoglobulinemia. The various signs that appear are most commonly due to underlying hyperviscosity and thrombosis.
Patients with cryoglobulinemia usually appear normal. Clinical manifestations that appear vary according to the type of cryoglobulinemia. The various signs that appear are most commonly due to underlying hyperviscosity and thrombosis.


===Vital Signs===
===Vital Signs===
Line 17: Line 17:


===Skin===
===Skin===
The cutaneous manifestations associated with cryoglobulinemia are as follows:<ref name="pmid7704562">{{cite journal| author=Monti G, Galli M, Invernizzi F, Pioltelli P, Saccardo F, Monteverde A et al.| title=Cryoglobulinaemias: a multi-centre study of the early clinical and laboratory manifestations of primary and secondary disease. GISC. Italian Group for the Study of Cryoglobulinaemias. | journal=QJM | year= 1995 | volume= 88 | issue= 2 | pages= 115-26 | pmid=7704562 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7704562  }} </ref> <ref name="pmid6996482">{{cite journal| author=Gorevic PD, Kassab HJ, Levo Y, Kohn R, Meltzer M, Prose P et al.| title=Mixed cryoglobulinemia: clinical aspects and long-term follow-up of 40 patients. | journal=Am J Med | year= 1980 | volume= 69 | issue= 2 | pages= 287-308 | pmid=6996482 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6996482  }} </ref><ref name="pmid1880249">{{cite journal| author=Cohen SJ, Pittelkow MR, Su WP| title=Cutaneous manifestations of cryoglobulinemia: clinical and histopathologic study of seventy-two patients. | journal=J Am Acad Dermatol | year= 1991 | volume= 25 | issue= 1 Pt 1 | pages= 21-7 | pmid=1880249 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1880249  }} </ref>
The cutaneous manifestations associated with cryoglobulinemia are as follows:<ref name="pmid7704562">{{cite journal| author=Monti G, Galli M, Invernizzi F, Pioltelli P, Saccardo F, Monteverde A et al.| title=Cryoglobulinaemias: a multi-centre study of the early clinical and laboratory manifestations of primary and secondary disease. GISC. Italian Group for the Study of Cryoglobulinaemias. | journal=QJM | year= 1995 | volume= 88 | issue= 2 | pages= 115-26 | pmid=7704562 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7704562  }} </ref><ref name="pmid6996482">{{cite journal| author=Gorevic PD, Kassab HJ, Levo Y, Kohn R, Meltzer M, Prose P et al.| title=Mixed cryoglobulinemia: clinical aspects and long-term follow-up of 40 patients. | journal=Am J Med | year= 1980 | volume= 69 | issue= 2 | pages= 287-308 | pmid=6996482 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6996482  }} </ref><ref name="pmid1880249">{{cite journal| author=Cohen SJ, Pittelkow MR, Su WP| title=Cutaneous manifestations of cryoglobulinemia: clinical and histopathologic study of seventy-two patients. | journal=J Am Acad Dermatol | year= 1991 | volume= 25 | issue= 1 Pt 1 | pages= 21-7 | pmid=1880249 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1880249  }} </ref>
*[[Leukocytoclastic vasculitis|Leukocytoclastic]] vasculitis
*Raynauds phenomenon
*Raynauds phenomenon
*Livedo reticularis
*Livedo reticularis
Line 23: Line 24:
*Digital ischemia
*Digital ischemia
*Acrocyanosis
*Acrocyanosis
<gallery widths="150px">
* Hyperkeratotic spicules in cold-exposed areas
 
*Cold induced urticaria
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
Line 38: Line 35:


===Lungs===
===Lungs===
* Pulmonary examination of patients with cryopglobulinemia is usually normal.
* Pulmonary examination of patients with cryopglobulinemia is postive for the following findings:<ref name="pmid443251">{{cite journal| author=Bombardieri S, Paoletti P, Ferri C, Di Munno O, Fornal E, Giuntini C| title=Lung involvement in essential mixed cryoglobulinemia. | journal=Am J Med | year= 1979 | volume= 66 | issue= 5 | pages= 748-56 | pmid=443251 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=443251  }} </ref><ref name="pmid2805608">{{cite journal| author=Viegi G, Fornai E, Ferri C, Di Munno O, Begliomini E, Vitali C et al.| title=Lung function in essential mixed cryoglobulinemia: a short-term follow-up. | journal=Clin Rheumatol | year= 1989 | volume= 8 | issue= 3 | pages= 331-8 | pmid=2805608 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2805608  }} </ref>
**Shortness of breath
**Cough
** Reduction in forced expiratory flow rates
** Pleural effusion findings


===Heart===
===Heart===
Line 51: Line 52:


===Genitourinary===
===Genitourinary===
*Hematuria
*[[Hematuria]] as a result of [[Membranoproliferative glomerulonephritis|membranoproliferative]] glomerulonephritis.<ref name="pmid4216269">{{cite journal| author=Brouet JC, Clauvel JP, Danon F, Klein M, Seligmann M| title=Biologic and clinical significance of cryoglobulins. A report of 86 cases. | journal=Am J Med | year= 1974 | volume= 57 | issue= 5 | pages= 775-88 | pmid=4216269 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4216269  }} </ref><ref name="pmid7723249">{{cite journal| author=Tarantino A, Campise M, Banfi G, Confalonieri R, Bucci A, Montoli A et al.| title=Long-term predictors of survival in essential mixed cryoglobulinemic glomerulonephritis. | journal=Kidney Int | year= 1995 | volume= 47 | issue= 2 | pages= 618-23 | pmid=7723249 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7723249  }} </ref>


===Neuromuscular===
===Neuromuscular===
Line 63: Line 64:


===Extremities===
===Extremities===
Extremities examination of patients with cryoglobulinemia usually have the following findings:
Extremities examination of patients with cryoglobulinemia usually have the following findings:<ref name="pmid3046019">{{cite journal| author=Montagnino G| title=Reappraisal of the clinical expression of mixed cryoglobulinemia. | journal=Springer Semin Immunopathol | year= 1988 | volume= 10 | issue= 1 | pages= 1-19 | pmid=3046019 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3046019  }} </ref>


*Digital [[ischemia]]/[[gangrene]]  
*Digital [[ischemia]]/[[gangrene]]  
Line 70: Line 71:
*Peripheral [[neuropathy]]
*Peripheral [[neuropathy]]
{| class="wikitable"
{| class="wikitable"
! colspan="4" |Physical examination findings according to the type of cryoglobulinemia
! colspan="3" |Physical examination findings according to the type of cryoglobulinemia
|-
|-
|'''Type 1'''
|'''Type 1'''
|'''Type 2'''
|'''Type 2'''
|'''Type 3'''
|'''Type 3'''
|'''Type 4'''
|-
|-
|Gangrene
|[[Gangrene]]
|
|Joint abnormalities
|
|[[Purpura]]
|
|-
|-
|Acrocyanosis
|[[Acrocyanosis]]
|
|[[Membranoproliferative Glomerulonephritis|Membranoproliferative]] glomerulonephritis
|
|
|
|}
|}
===Gallery===
<gallery>
Image:Atrophie Blanche01.jpg|Atrophie Blanche. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrophie Blanche02.jpg|Atrophie Blanche. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrophie Blanche03.jpg|Atrophie Blanche. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrophie Blanche04.jpg|Atrophie Blanche. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrophie Blanche05.jpg|Atrophie Blanche. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrophie Blanche06.jpg|Atrophie Blanche. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrophie Blanche07.jpg|Atrophie Blanche. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
Image:Atrophie Blanche08.jpg|Atrophie Blanche. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite
</gallery>


==References==
==References==

Latest revision as of 13:55, 30 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Physical examination of patients with cryoglobulinemia is usually remarkable for: purpura, arthralgia, and acrocyanosis. Type I cryoglobulinemia predominantly affects the kidney, skin and bone marrow whereas mixed CG (types II and III) predominantly involves the skin and peripheral nervous system. The various signs that appear are most commonly due to underlying hyperviscosity and thrombosis.

Physical Examination

Physical examination of patients with cryoglobulinemia is usually remarkable for: purpura, arthralgia, and acrocyanosis. Type I cryoglobulinemia predominantly affects the kidney, skin and bone marrow whereas mixed CG (types II and III) predominantly involves the skin and peripheral nervous system.

Appearance of the Patient

Patients with cryoglobulinemia usually appear normal. Clinical manifestations that appear vary according to the type of cryoglobulinemia. The various signs that appear are most commonly due to underlying hyperviscosity and thrombosis.

Vital Signs

Vital signs in patients with cryoglobulinemia are normal.

Skin

The cutaneous manifestations associated with cryoglobulinemia are as follows:[1][2][3]

  • Leukocytoclastic vasculitis
  • Raynauds phenomenon
  • Livedo reticularis
  • Palpable purpura
  • Digital ischemia
  • Acrocyanosis
  • Hyperkeratotic spicules in cold-exposed areas
  • Cold induced urticaria

HEENT

Neck

Lungs

  • Pulmonary examination of patients with cryopglobulinemia is postive for the following findings:[4][5]
    • Shortness of breath
    • Cough
    • Reduction in forced expiratory flow rates
    • Pleural effusion findings

Heart

  • Cardiovascular examination of patients with cryoglobulinemia is usually normal.

Abdomen

Back

  • Back examination of patients with cryoglobulinemia is usually normal.

Genitourinary

Neuromuscular

Extremities

Extremities examination of patients with cryoglobulinemia usually have the following findings:[8]

Physical examination findings according to the type of cryoglobulinemia
Type 1 Type 2 Type 3
Gangrene Joint abnormalities Purpura
Acrocyanosis Membranoproliferative glomerulonephritis

Gallery

References

  1. Monti G, Galli M, Invernizzi F, Pioltelli P, Saccardo F, Monteverde A; et al. (1995). "Cryoglobulinaemias: a multi-centre study of the early clinical and laboratory manifestations of primary and secondary disease. GISC. Italian Group for the Study of Cryoglobulinaemias". QJM. 88 (2): 115–26. PMID 7704562.
  2. Gorevic PD, Kassab HJ, Levo Y, Kohn R, Meltzer M, Prose P; et al. (1980). "Mixed cryoglobulinemia: clinical aspects and long-term follow-up of 40 patients". Am J Med. 69 (2): 287–308. PMID 6996482.
  3. Cohen SJ, Pittelkow MR, Su WP (1991). "Cutaneous manifestations of cryoglobulinemia: clinical and histopathologic study of seventy-two patients". J Am Acad Dermatol. 25 (1 Pt 1): 21–7. PMID 1880249.
  4. Bombardieri S, Paoletti P, Ferri C, Di Munno O, Fornal E, Giuntini C (1979). "Lung involvement in essential mixed cryoglobulinemia". Am J Med. 66 (5): 748–56. PMID 443251.
  5. Viegi G, Fornai E, Ferri C, Di Munno O, Begliomini E, Vitali C; et al. (1989). "Lung function in essential mixed cryoglobulinemia: a short-term follow-up". Clin Rheumatol. 8 (3): 331–8. PMID 2805608.
  6. Brouet JC, Clauvel JP, Danon F, Klein M, Seligmann M (1974). "Biologic and clinical significance of cryoglobulins. A report of 86 cases". Am J Med. 57 (5): 775–88. PMID 4216269.
  7. Tarantino A, Campise M, Banfi G, Confalonieri R, Bucci A, Montoli A; et al. (1995). "Long-term predictors of survival in essential mixed cryoglobulinemic glomerulonephritis". Kidney Int. 47 (2): 618–23. PMID 7723249.
  8. Montagnino G (1988). "Reappraisal of the clinical expression of mixed cryoglobulinemia". Springer Semin Immunopathol. 10 (1): 1–19. PMID 3046019.


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