History and admission findings: A 56-year-old man presented with fever, myalgia and weakness of the limbs for four weeks. The physical examination showed a skin rash, hepatomegaly and reduced mobility of the limbs due to pain.
Investigation: Laboratory tests revealed an elevated rheumatoid factor, cryoglobulins and were positive for hepatitis C-antibodies. The lung function tests indicated mild obstruction and a moderate decrease of diffusion capacity. Bronchoalveolar lavage showed lymphocytic alveolitis. Computed tomography of the thorax revealed mediastinal lymphadenopathy, diffuse ground-glass infiltrates and bilateral signs of fibrosis in the lower lung fields.
Diagnosis, treatment and course: Because of the fibrosing alveolitis associated with hepatitis C-related cryoglobulinemia, immunosuppression was started with high-dosage prednisone and azathioprine. The symptoms improved on this treatment.
Conclusion: Hepatitis C-related cryoglobulinemia is a rare condition that usually presents with nonspecific symptoms. Severe pulmonary involvement is very uncommon. There are no general guidelines about treatment.