Splenectomy may improve the glomerulopathy of type II mixed cryoglobulinemia

Many patients with type II mixed cryoglobulinemia have been shown to be inf ected with hapatitis C virus (HCV). Therefore, interferon-alfa has become t he first choice of treatment for patients with HCV-associated cryoglobuline mia. However, the disease often relapses after the discontinuation of inter feron therapy. The long-term effect of interferon therapy is controversial. Therefore, a more effective therapy needs to be developed, A 62-year-old J apanese woman was admitted to our hospital for the examination of abnormal liver function tests, severe edema, and purpura in her lower extremities. G lomerulopathy secondary to HCV-related cryoglobulinemia was suspected. Her serum creatinine was increased to 2.1 mg/dL. Interferon therapy was conside red initially, However, because of pancytopenia caused by liver cirrhosis a nd splenomegaly, splenectomy was performed in February 1997, before the sta rt of interferon therapy. Renal biopsy specimen taken at the time of the sp lenectomy showed typical cryoglobulinemic glomerulonephritis. Gradually, af ter surgery, the patient's thrombocytopenia and anemia improved, her protei nuria and hematuria were decreased, her cryocrit dropped from 15% to 5%, th e Ccr increased from 21.1 mL/min to 48.8 mL/min, and the purpura in her low er extremities disappeared. A repeat renal biopsy performed in May 1998 sho wed marked histological improvement. Splenectomy is not widely accepted as a treatment for cryoglobulinemia. Our case suggests the possibility that th e monoclonal-IgM component of the type II cryoglobulin may be formed in the spleen. In conclusion, splenectomy may be an effective therapy for cryoglo bulinemia in patients with HCV-positive liver cirrhosis and pancytopenia se condary to splenomegaly. (C) 2000 by the National Kidney Foundation, Inc.