ELECTRON-MICROSCOPIC AND IMMUNOCHEMICAL STUDIES IN A PATIENT WITH HEPATITIS-C VIRUS-INFECTION AND MIXED CRYOGLOBULINEMIA TYPE-II

The authors describe patient with hepatitis C virus (HCV) infection an d mixed cryoglobulinemia type II in whom multiorgan failure was associ ated with deposits of typical, electron-microscopically visualized par acrystalline tubules in the organs studied. The patient's plasma cryop recipitate was comprised of monoclonal IgM rheumatoid factor, polyclon al IgG, HCV RNA, and complement component C3. Of the polyclonal IgG, a lmost half was anti-HCV. The molar ratio between IgG and IgM was appro ximately 1.5 to 1. On peripheral blood films the cryoprecipitate forme d cloudlike structures, which may be a useful diagnostic clue in mixed cryoglobulinemia type II. The ultrastructure of plasma cryoprecipitat e and of deposits in skin, renal glomerular capillaries, and blood mon ocytes was identical. The cross-sectional diameter of the tubules was 30.7 +/- 1.6 nm (mean +/- 1 SD), and they appeared to be surrounded by eight electron-lucent dots. Deposition in organs of complexes contain ing HCV antigens and antibodies, rheumatoid factor, and C3 contributed to the multiorgan disease in this patient.