Abstract

We report on a 67-year-old female patient who was admitted to our intensive care unit with acute renal failure and severe hypoxemia. Transiently, the patient had to be treated with kidney replacement therapies and artificial ventilation. The actual illness started with general weakness, recurrent bloody diarrhea and intermittent dermatitis of the lower legs. Skin symptoms were initially observed 2 years before the actual clinical findings. The bloody diarrhea was attributed to an inflammatory stenosis of the sigma. The life-threatening clinical aggravation was due to diffuse alveolar hemorrhage and alveolitis. In the search for the cause of the systemic disease, both a monoclonal g-globulinemia, causing a cryoglobulinemia type II and an acute cytomegalovirus infection were diagnosed. Additionally, the course of the disease was complicated by a secondary antibody deficiency as well as an endocarditis of the aortic valve caused by Enterococcus faecium. A cryoglobulinemic vasculitis type II was histologically found in biopsy specimen of the kidney. Thus, the present case reports on a coincidence of a monoclonal gammopathy causing a cryoglobulinemia type II with extensive organ involvement and a florid CMV infection. We hypothesize that the CMV infection has triggered the cryoglobulinemia and its particular severe organ involvement.

Author Details

Authors

• J. Kramer¹
• H. Hennig²
• C. Lensing³
• S. Krüger⁴
• U. Helmchen⁵
• J. Steinhoff¹
• C. Dodt¹

Departments

• ¹ Medical Department
• ¹ ,
• ² Institute of Immunology and Transfusion Medicine,
• ³ Institute of Microbiology,
• ⁴ Institute of Pathology, University of Lübeck,
• ⁵ Institute of Pathology, University of Hamburg, Clinic Eppendorf, Hamburg, Germany

Address

Dr. J. Kramer
Medical Department 1
Division of Nephrology and Transplantation Unit
University Clinics of Schleswig-Holstein, Campus Lübeck
Ratzeburger Allee 160
23538 Lübeck, Germany
Email: [email protected]

Log in for Subscribers

Citation