Non–hepatitis virus associated mixed essential cryoglobulinemia

CASE PRESENTATIONA 42-year-old Indo-Asian woman presented to her local emergency department with a 1-week history of joint pains, fatigue, and episodic macroscopic hematuria. She was prescribed oral cephalexin and analgesia for a presumed urinary tract infection. Subsequently, she developed a skin rash, leg edema, and recurrent epistaxis, prompting withdrawal of her antibiotics. Her condition failed to improve over the ensuing week, and on return to the emergency department, she was found to have developed progressive edema, hematuria, and proteinuria on urine dipstick testing. Blood tests showed a rise in the serum creatinine over 1 week from 114 to 240 μmol/l. The patient was transferred to our renal unit for further investigation and management.