Crystal Cryoglobulinemia due to CLL

Author: Ashley Dunton, MD, 05/18/2023
Category: Lymphoma: Mature B-cell and Plasma cell Neoplasms > Low-grade B-cell lymphoma > Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
Published Date: 10/12/2023

A 64-year-old man presented with acute renal failure and was found to have crystal cryoglobulinemia in the setting of new chronic lymphocytic leukemia (CLL). His renal biopsy images demonstrated a membranoproliferative glomerulonephritis pattern of injury with intracapillary pseudothrombi and focal arteriolar thrombosis that stained positive for IgG and kappa on light microscopy. Ultrastructurally, global subendothelial and intraluminal electron dense deposits were seen. Many of these glomerular deposits displayed lattice-like substructures and some formed crystals in rod and rectangular shapes. Together, these findings were suggestive of IgG kappa crystal cryoglobulinemic glomerulonephritis type 1 with secondary vascular thrombosis in context of CLL.