Association between Hepatitis B Virus and Essential Mixed Cryoglobulinemia

Y. Levo, P. D. Gorevic, H. J. Kassab, D. Zucker-Franklin, E. C. Franklin

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In view of a high frequency of liver involvement in patients with essential mixed cryoglobulinemia, we looked for evidence for hepatitis B virus infection in 25 serum specimens and 19 cryoprecipitates obtained from 30 patients. Three of the 25 serum specimens contained HBs Ag, and 12 had antibody. The frequency of positive results was increased to six and 11 of 19 respectively when cryoprecipitates were examined, and 14 of 19 (74 per cent) of the cryoprecipitates were positive for either HBs Ag or its antibody. Electron microscopy of four cryoprecipitates showed structures resembling the 20-nm and 27-nm spheres, tubules, as well as the Dane particles characteristic of hepatitis B virus infection. Since such infection appears to be involved in the pathogenesis of the syndrome, the term “essential mixed cryoglobulinemia” should be replaced by “mixed cryoglobulinemia secondary to hepatitis B virus” or perhaps to other viral infections. (N Engl J Med 296:1501–1504, 1977) Essential mixed cryglobulinemia unassociated with a well defined connective-tissue dissease, lymphoreticular neoplasia or obvious infectious process1 is a syndrome characterized by the clinical traid of purpura, arthralgia and weakness, frequently accompanied by renal involvement that can be rapidly progressive. Histologic examination reveals widespread vasculitis, with immune-complex deposition. An important role for the mixed crygolbulins in the pathogenesis of the immune-complex vasculitis has been suggested by the deposits of IgG, IgM and complement at the sites of disease, and the low levels of serum complement in many of the subjects1 2 3 4 The cryoglobulins have been shown to consist most often of IgG.

Original languageEnglish
Pages (from-to)1501-1504
Number of pages4
JournalNew England Journal of Medicine
Issue number26
StatePublished - 30 Jun 1977
Externally publishedYes


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