ORAL COMMUNICATION | A diagnostic challenge: cryoglobulinemic vasculitis manifesting with interstitial lung disease, mesenteric panniculitis and myelodysplasia

Introduction. Mixed cryoglobulinemia is a systemic vasculitis frequently associated with Hepatitis C virus (HCV) infection. Its clinical presentation is highly polymorphic, often leading to significant diagnostic delays when unusual organ involvement occurs.

Description. We report the case of an HCV-positive patient presenting with a complex multisystemic clinical picture. Initial evaluations revealed interstitial lung disease (ILD) and imaging findings consistent with mesenteric panniculitis (mesenteritis). Concurrently, the patient exhibited persistent cytopenia; a bone marrow biopsy was performed, confirming the suspicion of myelodysplastic syndrome (MDS). Given the coexistence of HCV, pulmonary involvement, and abdominal inflammatory findings, a systemic vasculitis was suspected. Further laboratory testing confirmed the presence of circulating cryoglobulins and low complement levels. The final diagnosis was identified as HCV-related cryoglobulinemic vasculitis. This systemic process unified the seemingly disparate findings of ILD, mesenteric involvement, and the hematological abnormalities mimicking MDS.

Conclusions. This case highlights the "chameleonic" nature of cryoglobulinemia. It emphasizes the necessity of screening for cryoglobulins in HCV-positive patients presenting with atypical manifestations like interstitial pneumonia or mesenteric inflammation. Recognizing this association is crucial to initiating targeted antiviral and immunosuppressive therapy, potentially reversing multi-organ damage.