Chronic hepatitis and cirrhosis of the liver in cryoglobulinaemia

SUMMARY Hepatic biopsy showed either persistent or aggressive chronic hepatitis in 11 patients with cryoglobulinaemia not attributable to known disease entities, whereas liver impairment was not in every case suggested by either physical examination or functional abnormalities. The incidence was predominantly in women and cryoglobulin behaviour was similar in these patients and in five subjects with cirrhosis-associated cryoglobulinaemia. It is concluded that liver disease should be included among the constant features of the cryoglobulin-associated syndrome, and the speculation is advanced that in cryoglobulinaemic patients both cirrhosis and chronic hepatitis may be caused by the same pathogenic mechanism(s). Cryoglobulinaemia refers to the presence of plasma proteins that reversibly precipitate on cooling. Although most commonly associated with multiple myeloma, macroglobulinaemia, and malignant lym-phomas, cryoglobulins have been also encountered in a variety of diseases, including cirrhosis of the liver (Griffiths and Gilchrist, 1953). On the other hand, serum cryoglobulins have been detected in patients who did not fit into any hitherto described clinical entity (Meltzer, Franklin, Elias, McKlusky, and Cooger, 1966), a condition usually (and un-satisfactorily) referred to as 'essential cryoglobulin-aemia ' (Goldberg and Barnett, 1970). Indeed, hepatosplenomegaly has been so frequently reporte