A 50-year-old female patient, known case of hepatitis C presented to the OPD with joint pains, myalgia, fatigue, recurrent skin infections and symptoms of peripheral neuropathy. O/E: - Acrocyanosis Livedo reticularis Purpura Lab studies, Deranged RFTs with proteinuria Leukocytosis ANA positivity Raised ESR Kidney biopsy was done. What is the diagnosis: -

This is a case of Essential mixed cryoglobulinemia. Any case of glomerulonephritis occurring in the setting of hepatitis C is either MPGN or Essential mixed cryoglobulinemia. As in MPGN, there will no skin lesions or any joint involvement will be seen whereas in Cryoglobulinemia these findings will be present. Essential mixed cryoglobulinemia Presence of cryoglobulins in the serum. These result in a clinical syndrome of systemic inflammation (most commonly affecting the kidneys and skin) The syndrome is caused by cryoglobulin-containing immune complexes. Present with features of thrombosis and hyperviscosity These are acrocyanosis, livedo reticularis and purpura. Joint involvement is seen (Ahralgia in PIP, MCP, knee and ankle joints) Associated with Hepatitis C infection.