Successful combination of Rituximab and plasma exchange in the treatment of cryoglobulinemic vasculitis with skin ulcers: a case report

INTRODUCTION Type II mixed cryoglobulin syndrome is a systematic vasculitis mainly linked to immune complex deposition in several organs and to hepatitis C virus infection. Therapeutic strategies can target either the viral trigger hepatitis C virus if present, or pathogenic events downstream the triggering infection, e.g, the proliferation B-cells directly. Antiviral therapy should be considered as a first-line treatment in many HCV-positive patients. However, it may prove ineffective, contraindicated, or poorly tolerated. The other available treatment [such as cytotoxic agents, steroids] may lead to life-threatening complications and may be difficult to manage in the long term. CASE PRESENTATION We report on a 75-year-old patient with long-lasting hepatitis C virus infection [18 years], a long-lasting cryoglobulinemia [7 years] resistant to common antiviral therapy, diabetes mellitus and deep skin ulcers, successfully treated with the combination therapy of Rituximab and plasma exchange. CONCLUSION Plasma exchange in combination with Rituximab may be useful to heal skin in those patients who are non responsive to Rituximab alone, by avoiding a leg amputation.