CRYOGLOBULINEMIC NEUROPATHY: A CLINICAL STUDY OF 25 CASES

Cryoglobulinemic neuropathy is probably the commonest form of vasculitic neuropathy, at least in Southern Europe. We studied 25 patients (19 females, 6 males) with symptomatic cryoglobulinemic neuropathy (HCV-related in all patients but 4) clinically evident, and confirmed by neurophysiological study. Cryoglobulin was type 2 in 17 cases, type 3 in 4 cases, and not characterized in 4 cases. Neuropathy was more often in form of asymmetrical (mainly) sensory polyneuropathy (11 cases); other forms included symmetrical sensory polyneuropathy (8 cases), sensorimotor polyneuropathy (2 cases), and mononeuropathy multplex (4 cases). Neuropathy was often the presenting manifestation of the disease (16 cases), usually in association with purpura (9 cases). Purpura was the commonest non-neurological manifestation (21 cases), and was especially severe in frequency and intensity in 11 cases. Purpura of relevant entity tended to be associated with more severe features of neuropathy, on clinical and neurophysiological grounds, and worsening course. Severe purpura was more often associated with asymmetrical neuropathy or mononeuropathy multiplex. Hepatic involvement, relevant in 7 cases and mild in 11 cases, did not correlate with the severity of neuropathic manifestations. Peripheral nerve involvement in mixed cryoglobulinemia has heterogeneous features, but factors conditioning its expression are poorly known. Our study suggests that the severity of neuropathy is correlated with purpura thus the pathogenic mechanisms of cutaneous and neurological manifestations may be interconnected.