LETTER

Cryoglobulinaemic vasculitis as presenting manifestation of infective endocarditis

L La Civita¹, P Fadda¹, I Olivieri¹, C Ferri²

¹ Rheumatology Department of Lucania, S Carlo Hospital, Contrada Macchia Romana, 85100 Potenza, Italy
² Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy

Correspondence to:
Correspondence to:
Dr Luca La Civita, Rheumatology Department of Lucania, Azienda Ospedaliera S Carlo, Contrada Macchia Romana, 85100 Potenza, Italy

Keywords: vasculitis; endocarditis

Seroimmunological alterations, including antibodies and/or cryoglobulins, are common in infective endocarditis (IE)¹; however, specific autoimmune disorders, such as cryoglobulinaemic vasculitis (CV) associated with IE have seldom been described.^2–5 CV is related to the vascular deposition of circulating immune complexes, mainly cryoglobulins, and complement^5,6; in 70–90% of patients with CV a triggering role of hepatitis C virus (HCV) has been suggested.^7,8 We report the case of two patients who showed a typical CV with severe neurological involvement as the presenting manifestation of underlying IE.

In November 1994 a 63 year old woman presented with fever, purpura, paraesthesias, and pseudoataxic gait. Her past clinical history was unremarkable except for a prosthetic implant of the left hip four years previously. Table 1 shows the main clinicoserological features. Repeated blood cultures were negative. Neurological examination showed abnormal tactile sensation in the arms and legs; mild ideomotor slowing down; shaky movements; and unsteady . . . [Full text of this article]

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