Cryoglobulinaemic vasculitis as presenting manifestation of infective endocarditis

Seroimmunological alterations, including antibodies and/or cryoglobulins, are common in infective endocarditis (IE)1; however, specific autoimmune disorders, such as cryoglobulinaemic vasculitis (CV) associated with IE have seldom been described.2–5 CV is related to the vascular deposition of circulating immune complexes, mainly cryoglobulins, and complement5,6; in 70–90% of patients with CV a triggering role of hepatitis C virus (HCV) has been suggested.7,8 We report the case of two patients who showed a typical CV with severe neurological involvement as the presenting manifestation of underlying IE. In November 1994 a 63 year old woman presented with fever, purpura, paraesthesias, and pseudoataxic gait. Her past clinical history was unremarkable except for a prosthetic implant of the left hip four years previously. Table 1 shows the main clinicoserological features. Repeated blood cultures were negative. Neurological examination showed abnormal tactile sensation in the arms and legs; mild ideomotor slowing down; shaky movements; and unsteady gait. An electrophysiological study recorded a moderate sensorimotor …