Recommendations for managing the manifestations of severe and life-threatening mixed cryoglobulinemia syndrome.

Objective: Some of the manifestations of mixed cryoglobulinemia syndrome (MCS) can be severe or life-threatening, and should be rapidly contained but, as the therapeutic approaches to such conditions are largely based on anecdotal data, a consensus conference was organised by the Italian Group for the Study of Cryoglobulinemia (GISC) with the aim of providing a set of recommendations based on an in-depth survey of the available data and expert opinion.

Methods: The consensus panel, which included specialists working in different medical fields involved in the management of MCS patients, was first asked to divide the manifestations of MCS into severe or life-threatening conditions on the basis of their own experience, after which a complete literature review was carried out in accordance with the Cochrane guidelines for systematic reviews.

Results: Therapeutic plasma exchange (TPE) was considered the elective first-line treatment in the case of life-threatening manifestations of MCS (LT-MCS) and patients with severe clinical symptoms (S-MCS) who fail to respond to (or who are ineligible for) other treatments.

Prevalence of mixed cryoglobulinaemia syndrome and circulating cryoglobulins in a population-based survey: the Origgio study.

Mixed cryoglobulinaemia syndrome (MCS) is associated with a number of infectious, autoimmune and lymphoproliferative disorders, particularly chronic hepatitis C infection. Although circulating mixed cryoglobulins (cMCGs) are a frequent finding in HCV-infected patients, only a minority of them develop a frank MCS. The only available data concerning the prevalence of MCS, which is generally considered a rare disease, come from hospital records.

Causes of death in symptomatic cryoglobulinemia: 30 years of observation in a Department of Internal Medicine.

Unlabelled: Cryoglobulinemic Syn&come (CS) is a multi-systemic disease, and its fatal evolution can involve different organs.

Aims: To describe the most frequent causes of death in CS, by researching different evolutions between older cases and those of the last 15 years.

Patients: The data of 238 patients affected by symptomatic cryoglobulinemia followed by our Medicine Department in the last 30 years are recorded in a database.

[Carbamazepine-induced agranulocytosis. Apropos of 2 cases].

Carbamazepine-induced agranulocytosis (CIA) is a rare event. We report on two cases, highlighting the wide variability of the bone marrow, which may show pseudohypercellularity with disappearance of neutrophils and excess of immature cells (myeloblasts and promyelocytes), thus mimicking the features of acute myeloid leukemia. Although its pathogenesis is still unclear, CIA must be considered as an idiosyncratic hemopathy and moreover it appears to be an unpredictable complication among patients taking the drug.

[2 cases of acute cholestasis caused by ticlopidine].

We report the case of two patients suffered from cholestatic jaundice occurred 3-4 weeks after starting ticlopidine therapy. In both cases the diagnosis was made by ruling out any other known cause of acute hepatitis or cholestasis. One patient underwent liver biopsy, which showed a typical intralobular cholestatic pattern and a slight lymphocytic infiltration of the portal tracts.