A Case of Type II Cryoglobulinemic Membranoproliferative GlomerulonephritisAssociated with Marginal Zone B Cell Lymphoma

Introduction: Cryoglobulinemia is rare. Renal involvement is seen some cases associated with type II cryoglobulinemia. We present a case of type II Cryoglobulinemic MPGN associated with Marginal Zone B-cell Lymphoma and response to the treatment. Case Description: A 74-year-old male with history of HTN, DM II, recent LE DVT presented to the hospital with worsening SOB, lower extremity edema, intermittent abdominal pain associated with nausea for 2 days. Upon arrival his BP was 168/79 mmHg. On exam, bibasilar crackles and +1 LE pitting edema. Labs revealed SCr 5.8 mg/dl (baseline 1.5 mg/dl). UA was positive for protein & RBC. Complements C3 and C4 were low. ANA was negative and RF level 1104. Cytology revealed positive cryoglobulin, Hep B core total and sIgG antibody positive with undetectable viral load. Hep C and HIV were negative. Immunofixation showed prominent IgM kappa. Kidney biopsy revealed B-cell lymphoma associated type II cryoglobulinemic glomerulonephritis. Immunofluorescence studies revealed glomerulus immune deposits of IgM and Kappa. Omental mass biopsy showed Marginal zone B-cell lymphoma. He was started on Rituximab and Methylprednisolone. After 3 months of treatment, his renal function improved to 1.5 mg/dl. He developed rash after first few doses of Rituximab. Discussion: Noninfectious type II cryoglobulinemic GN associated with marginal zone lymphoma is uncommon. Management and prognosis is dependent on disease severity and treatment of underlying cancer.Proliferative GNRash after Rituximab