Peripheral Neuropathy in Monoclonal Gammapathy with Cryoglobulinemia and Arteritis

Abstract

A patient with Ig[immunoglobulin]M gammapathy, cryoglobulinemia, Raynaud''s phenomena, purpura hyperglobulinemica of the legs and polyneuropathy was reported. Endoneuronal vasculitis with infiltrations of eosinophilic and neutrophilic granulocytes and an extensive loss or Wallerian degeneration of myelinated nerve fibers were seen on histopathologic examination of a sural nerve biopsy specimen. The microscopic picture differed somewhat from that observed previously in cryoglobulinemic vasculitis. Although vasculitis is most often believed to represent an immunologically mediated lesion, an alternate explanation was proposed, namely, that the disease manifestations in the present case were secondary to cold-induced effects of the cryoglobulin on the microcirculation.