Abstract: SA-PO0727
Fulminant Cryoglobulinemic Glomerulonephritis Seven Years After Viral Eradication: A Case Report
Session Information
- Glomerular Diseases: Complement-Mediated Glomerulopathies and Infection-Related GN
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Mubarak, Anees Mohammed, University of Benghazi, Benghazi, Benghazi District, Libya
- Khalid, Saber, University of Benghazi, Benghazi, Benghazi District, Libya
- Almabry, Hussin Sameh, Tobruk University, Tobruk, Butnan District, Libya
- Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States
- Mohamed, Muner, Ochsner Health, New Orleans, Louisiana, United States
Group or Team Name
- Ochsner Nephrology
Introduction
Type II mixed cryoglobulinemic glomerulonephritis (CryoGN) is classically associated with active hepatitis C virus (HCV) infection or lymphoproliferative disorders. We present an unusual case of biopsy-proven type II CryoGN occurring 7 years after HCV eradication, potentially triggered by a recent pro-inflammatory “second-hit” in the setting of low-level monoclonal gammopathy
Case Description
A 70-year-old male with a history of HCV cirrhosis [sustained virologic response (SVR) since 2019, undetectable RNA from 2019 to March 2026], presented with a generalized pruritic morbilliform rash and rapidly progressive acute kidney injury. He underwent left above-knee amputation complicated by MRSA abscesses. Laboratory studies revealed serum creatinine of 3.4 mg/dL (baseline 0.7), nephrotic-range proteinuria (urine protein/creatinine ratio 5 g/g), microscopic hematuria with acanthocytes and red blood cell casts, hypocomplementemia (low C3 and C4), positive rheumatoid factor, and an IgM kappa monoclonal band. Kidney biopsy demonstrated glomerular lesions with a membranoproliferative pattern with endocapillary hypercellularity, hyaline pseudothrombi, and double contours; immunofluorescence showed IgG (3+), IgM (3+), C3 (2+), and C1q (2+) deposits within the hyaline pseudothrombi, with equal kappa and lambda light chains staining (+3), whereas electron microscopy revealed mesangial deposits, swollen endothelial cells and glomerular basement membrane duplication, all findings consistent with CryoGN. The patient received steroids, rituximab was not started becasue of case deterioration, required hemodialysis but eventually developed hypoxic respiratory failure and died within 3 weeks of presentation
Discussion
This case illustrates that type II CryoGN can emerge despite long-standing HCV eradication when triggered by an intense pro-inflammatory state. We posit that recent surgical trauma and MRSA infection acted as a catalyst, driving a pre-existing, low-level IgM kappa paraprotein to form pathologic cryoglobulins independent of active HCV replication. Cryoglobulinemia should remain in the differential for patients with a history of HCV (regardless of SVR status) presenting with new-onset rash and proteinuria/hematuria, following inflammatory triggers