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Introduction Occult hepatitis B virus (HBV) infection, defined as negative hepatitis B surface antigen (HBsAg) but detectable HBV DNA in serum and liver tissue, has very rarely been described in cryoglobulinemia (CG) patients. This case report sheds light on the possible link between occult HBV infection and CG. Patient concerns A 76-year-old man presented with rapidly deteriorating renal function within 1 year. Diagnosis Cryoglobulinemic glomerulonephritis was diagnosed through renal biopsy. Initially, the patient tested negative for HBsAg, but a low HBV viral load was later discovered, indicating an occult HBV infection. Further studies also revealed Waldenstrom macroglobulinemia (WM). Interventions We treated the patient as WM using plasma exchange and rituximab-based immunosuppressive therapy. Outcomes After 1 cycle of immunosuppressive treatment, there was no improvement of renal function. Shortly after, treatment was discontinued due to an episode of life-threatening pneumonia. Hemodialysis was ultimately required. Conclusion Future studies are needed to explore the link between occult HBV infection and CG, to investigate the mediating role of lymphomagenesis, and to examine the effectiveness of anti-HBV drugs in treating the group of CG patients with occult HBV infection. We encourage clinicians to incorporate HBV viral load testing into the evaluation panel for CG patients especially in HBV-endemic areas, and to test HBV viral load for essential CG patients in whom CG cannot be attributed to any primary disease.

Fuzi (lateral root of Aconitum carmichaelii) has been used for millennia in Traditional Chinese Medicine (TCM) and Ayurveda to treat cancer and cardiovascular diseases. Fuzi must be processed before use to decrease the concentration of its toxic alkaloids. Detoxification during processing occurs through the transformation of diester-diterpenoid alkaloids (DDAs) to monoester-diterpenoid alkaloids (MDAs). However, traditional detoxification methods are time-consuming and expensive on large-scale production. To develop efficient detoxification protocols to reduce unnecessary processing procedure and keep the maximum functional contents from raw Fuzi, we replicated the traditional procedure and quantified the DDAs and MDAs by UPLC-MS/MS and UPLC-PDA during different steps and conditions of processing. With due consideration of obtained data, we concluded that soaking in Danba solution and the washing steps were inefficient traditional processing methods. The detoxification effect of steaming (56.3 ± 0.27 μg/g DDAs, lowest after steaming) was weaker and slower than boiling (5.8 ± 0.33 μg/g DDAs, lowest after boiling). Moreover, roasting at 105℃ showed better effect in lowering the DDAs (5.8 ± 0.33 μg/g DDAs) and increasing the MDAs (729.1 ± 1.22 μg/g MDAs, highest) than roasting at 60℃ (17.3 ± 0.65 μg/g DDAs; 504.0 ± 0.99 μg/g MDAs). With these highly reliable analytic data, we established an efficient and referenceable detoxification protocol for Fuzi TCM products, in which DDAs and MDAs should legitimately follow the safe and specific ranges stipulated in pharmacopeias.