Type I cryoglobulinemia is associated with all the following EXCEPT

Cryoglobulins are antibodies directed against other immunoglobulins, and which form immune complexes that precipitate in the cold. type1 type 2 type 3 Immunoglobulinisotype and specificity Isolated monoclonal IgMparaprotein with no paicularspecificity Immune complexes formed bymonoclonal IgM paraproteindirected towards constant regionof IgG Immune complexes formed bypolyclonal IgM or IgG directedtowards constant region of IgG Prevalence 25% 25% 50% Disease association Lymphoproliferative disease,especially Waldenstrommacroglobulinaemia Infection, paicularly hepatitis Band hepatitis C;lymphoproliferative disease Infection, paicularly hepatitis Band C; autoimmune disease,including rheumatoid ahritisand SLE Symptoms Hyperviscosity:Raynaud's phenomenonAcrocyanosisRetinal vessel occlusionAerial and venous thrombosis Small-vessel vasculitis:Purpuric rashAhralgiaCutaneous ulcerationHepatosplenomegalyGlomerulonephritisRaynaud's phenomenon Small-vessel vasculitis:Purpuric rashAhralgiaCutaneous ulcerationHepatosplenomegalyGlomerulonephritisRaynaud's phenomenon Proteinelectrophoresis Monoclonal IgM paraprotein Monoclonal IgM paraprotein No monoclonal paraprotein Rheumatoid factor -ve strongly +ve +ve Complement Normal decreased c4 decreased c4 REF:DAVIDSON'S PRINCIPLES AND PRACTICE OF MEDICINE 22nd EDITION PAGE NO 88