Cryoglobulinemia vasculitis is a small-vessel systemic vasculitis.1 The most common type is mixed cryoglobulinemia (MC), which is associated with hepatitis C virus (HCV), although autoimmune disorders such as systemic lupus erythematosus, primary Sjögren's syndrome or rheumatoid arthritis have also been described with MC.

A 51-year-old man had a diagnosis of anti-cyclic citrullinated peptide antibodies (anti-CCP) positive non-erosive rheumatoid arthritis in 2006 without cryoglobulinemia, and the disease was well controlled using leflunomide. Since April 2010, asthenia, muscular pain, arthralgias and bilateral foot paresthesias occurred. There was a presence of purpura with bilateral hypoesthesia in the common fibular nerve territory (left first toe levator weakness at 2/5), but no joint swelling. C-reactive protein and fibrinogen were …