Cryoglobulinemia physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
Physical Examination
- Physical examination of patients with cryoglobulinemia is usually remarkable for: purpura, arthralgia, and acrocyanosis. Type I cryoglobulinemia (monoclonal immunoglobulins) predominantly affects the skin, kidney, and bone marrow and mixed CG (types II and III) predominantly involves the skin and peripheral nervous system.
Appearance of the Patient
- Patients with cryoglobulinemia usually appear normal. Clinical manifestations that appear vary according to the type of cryoglobulinemia. The various signs that appear are most commonly due to underlying hyperviscosity and thrombosis.
Vital Signs
Vital signs in patients with cryoglobulinemia are normal.
Skin
The cutaneous manifestations associated with cryoglobulinemia are as follows:[1][2][3]
- Raynauds phenomenon
- Livedo reticularis
- Palpable purpura
- Digital ischemia
- Acrocyanosis
-
Description (Adapted from Dermatology Atlas)
-
Description (Adapted from Dermatology Atlas)
HEENT
- Nystagmus
- Retinal hemorrhage
Neck
Lungs
- Pulmonary examination of patients with cryopglobulinemia is postive for the following findings:[4][5]
- Shortness of breath
- Cough
- Reduction in forced expiratory flow rates.
Heart
- Cardiovascular examination of patients with cryoglobulinemia is usually normal.
Abdomen
Back
- Back examination of patients with cryoglobulinemia is usually normal.
Genitourinary
- Hematuria as a result of membranoproliferative glomerulonephritis.[6][7]
Neuromuscular
Extremities
Extremities examination of patients with cryoglobulinemia usually have the following findings:
- Digital ischemia/gangrene
- Fasciculations in the upper/lower extremity
- Joint involvement most commonly in knees, ankles, proximal interphalangeal joints.
- Peripheral neuropathy
| Physical examination findings according to the type of cryoglobulinemia | ||
|---|---|---|
| Type 1 | Type 2 | Type 3 |
| Gangrene | Joint abnormalities | Purpura |
| Acrocyanosis | Membranoproliferative glomerulonephritis | |
References
- ↑ Monti G, Galli M, Invernizzi F, Pioltelli P, Saccardo F, Monteverde A; et al. (1995). "Cryoglobulinaemias: a multi-centre study of the early clinical and laboratory manifestations of primary and secondary disease. GISC. Italian Group for the Study of Cryoglobulinaemias". QJM. 88 (2): 115–26. PMID 7704562.
- ↑ Gorevic PD, Kassab HJ, Levo Y, Kohn R, Meltzer M, Prose P; et al. (1980). "Mixed cryoglobulinemia: clinical aspects and long-term follow-up of 40 patients". Am J Med. 69 (2): 287–308. PMID 6996482.
- ↑ Cohen SJ, Pittelkow MR, Su WP (1991). "Cutaneous manifestations of cryoglobulinemia: clinical and histopathologic study of seventy-two patients". J Am Acad Dermatol. 25 (1 Pt 1): 21–7. PMID 1880249.
- ↑ Bombardieri S, Paoletti P, Ferri C, Di Munno O, Fornal E, Giuntini C (1979). "Lung involvement in essential mixed cryoglobulinemia". Am J Med. 66 (5): 748–56. PMID 443251.
- ↑ Viegi G, Fornai E, Ferri C, Di Munno O, Begliomini E, Vitali C; et al. (1989). "Lung function in essential mixed cryoglobulinemia: a short-term follow-up". Clin Rheumatol. 8 (3): 331–8. PMID 2805608.
- ↑ Brouet JC, Clauvel JP, Danon F, Klein M, Seligmann M (1974). "Biologic and clinical significance of cryoglobulins. A report of 86 cases". Am J Med. 57 (5): 775–88. PMID 4216269.
- ↑ Tarantino A, Campise M, Banfi G, Confalonieri R, Bucci A, Montoli A; et al. (1995). "Long-term predictors of survival in essential mixed cryoglobulinemic glomerulonephritis". Kidney Int. 47 (2): 618–23. PMID 7723249.