A 52 year old male presented with features of purpura, ahralgia, neuropathy and glomerulonephritis. Low hemoglobin and high ESR was noticed in blood routine examination with mild alteration in the LFT with mild transaminase elevation. He has h/o blood transfusion in 1987 following an accident, at district hospital. What will be underlying pathology in this clinical setting?

Palpable purpura, ahralgia, neuropathy and glomerulonephritis are features of essential mixed cryoglobulinemia (EMC). Most cases of EMC are associated with chronic HCV infection. Chronic HCV infection produces asymptomatic transaminase elevation. Proper screening tests for HCV was not available in 1987 and blood transfusion in that period is a risk factor for HCV infection. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2798