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Efficacy of tocilizumab in rituximab-refractory cryoglobulinemia vasculitis
  1. Camille Cohen1,
  2. Arsene Mekinian1,
  3. Nathalie Saidenberg-Kermanac'h2,
  4. Jerôme Stirnemann1,
  5. Pierre Fenaux3,
  6. Romain Gherardi4,
  7. Olivier Fain1
  1. 1Service de médecine interne, Université Paris 13, AP-HP, Hôpital Jean Verdier, 93140, Bondy, France
  2. 2Service de rhumatologie, Université Paris 13, AP-HP, Hôpital Avicenne, 93000, Bobigny, France
  3. 3Service d’hématologie, Université Paris 13, AP-HP, Hôpital Avicenne, 93000, Bobigny, France
  4. 4Service de pathologie, Université Paris 12, AP-HP, Hopital Henri Mondor, 94000, Créteil, France
  1. Correspondence to Camille Cohen, Hôpital Jean Verdier, médecine interne, Avenue du 14 juillet, Bondy, France, 93140; camille.c.cohen{at}

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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 …

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  • Ethics approval consent form was obtained from the patient and was approved by the local commitee of the drug therapy.

  • Competing interests No, there are no competing interests

  • Provenance and peer review Not commissioned; externally peer reviewed

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