Treatment of polyneuropathy due to cryoglobulinemia with intravenous immunoglobulin and prednisolone

A 71-year-old man with cryoglobulinemia associated with severe symmetrical sensorimotor polyneuropathy was successfully treated with intravenous immun oglobulin (IVIG) and a corticosteroid. Within 2-3 months, he developed dist al motor a nd sensory deficits and burning feet deteriorating after cold ex posure. On examination, symmetric hypesthesia and hypalgesia were found alo ng with bilateral loss of vibration and position sense, loss of ankle jerks ,and paralysis of the pretibial muscles with steppage gait. The laboratory exam revealed elevated cryoglobulin levels and reduced complement C4. Nerve conduction studies were consistent with a severe axonal sensorimotor polyn europathy, Sural nerve biopsy showed chronic neuropathy with an acute compo nent. The patient underwent a combined treatment with prednisolone (initial ly 100 mg) and intravenous immunoglobulin. His condition markedly improved after almost a year of treatment. Unfortunately, the treatment with intrave nous immunoglobulin had to be interrupted due to an allergic reaction after the sixth application.