A 60 year old woman presents with generalized edema, skin ulceration and hypeension. Urine examination shows subnephrotic proteinuria (< 2gm) and microscopic haematuria. Serum complement levels are decreased and she is positive for anti- hepatitis c antibodies. The likely diagnosis is -

Essential mixed cryoglobulinemia is characterized by joint pains and swelling (ahritis), enlargement of the spleen, skin vasculitis with purplish patches, and nerve and kidney disease. This can lead to recurrent pain in the abdomen, hea attack, and bleeding in the lungs Essential mixed cryoglobulinemia is treated with combinations of medications which reduce inflammation and suppress the immune system. Medications used include nonsteroid antiinflammatory drugs (ibuprofen, aspirin, and others), steroids (prednisone, prednisolone), cyclophosphamide (Cytoxan), chlorambucil (Leukeran), and azathioprine (Imuran). Plasmapheresis (hemapheresis), a procedure whereby the blood's serum is filtered to remove the cryoglobulins, is also performed for severe symptoms. Ref Harrison20th edition pg 287