Cryoglobulinaemic vasculitis — SCE Rheumatology MCQ

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ModerateVasculitisCryoglobulinaemic vasculitisSCE Rheumatology

A 56-year-old man has palpable purpura, peripheral neuropathy and arthralgia. C4 is very low, rheumatoid factor is positive and hepatitis C antibody is positive. Serum cryoglobulins are detected. Urinalysis shows protein and microscopic haematuria. What is the most likely diagnosis?

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Correct answer: D — Cryoglobulinaemic vasculitis

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

Cryoglobulinaemic vasculitis is best because purpura, neuropathy, low C4, RF positivity and hepatitis C with cryoglobulins are typical of mixed cryoglobulinaemic vasculitis. A is less suitable because systemic sclerosis causes vasculopathy rather than immune-complex purpura; B is less suitable because gout does not cause low complement purpura and neuropathy; D is less suitable because osteoarthritis is non-inflammatory and localised to joints; E is less suitable because GPA usually has ENT/lung/renal granulomatous features and ANCA positivity. Clinical pearl: cryoglobulin testing requires warm handling of the sample to avoid false negatives.

Reference: EULAR vasculitis recommendations; Oxford Textbook of Rheumatology