{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:40:16Z","timestamp":1756359616872,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,5,17]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>We present a case of a woman in her 50s with chronic hepatitis B (CHB) who had a longstanding history of arthralgia and swollen joints associated with severe fatigue. Investigations were consistent with a diagnosis of hepatitis B virus (HBV)-related cryoglobulinaemia. Two months after treatment with tenofovir alafenamide, an antiviral therapy for HBV, there was a significant improvement of her symptoms and undetectable serum cryoglobulins. Cryoglobulinaemia is a relatively rare extrahepatic manifestation of HBV infection and only presents in about 2%\u20134% of the patients with CHB. Its clinical manifestations include purpura, renal dysfunction, arthralgias and neuropathy. Since the presentation of cryoglobulinaemia in CHB can be non-specific, one needs to have a high index of suspicion to avoid delay in diagnosis and treatment.<\/jats:p>","DOI":"10.1136\/bcr-2022-249630","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T10:35:19Z","timestamp":1653647719000},"page":"e249630","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Case of cryoglobulinaemia associated with chronic hepatitis B"],"prefix":"10.1136","volume":"15","author":[{"given":"Himabindu","family":"Kolli","sequence":"first","affiliation":[{"name":"Department of Medicine, The University of Texas Rio Grande Valley School of Medicine, Weslaco, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3313-9933","authenticated-orcid":false,"given":"Mukarram Jamat","family":"Ali","sequence":"additional","affiliation":[{"name":"Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5151-9134","authenticated-orcid":false,"given":"Karen J","family":"Campoverde Reyes","sequence":"additional","affiliation":[{"name":"Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daryl T-Y","family":"Lau","sequence":"additional","affiliation":[{"name":"Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,5,27]]},"reference":[{"key":"2025082722113185000_15.5.e249630.1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(74)90852-3"},{"key":"2025082722113185000_15.5.e249630.2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(80)90390-3"},{"key":"2025082722113185000_15.5.e249630.3","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.1002\/art.41003","article-title":"Cryoglobulins today: detection and immunologic characteristics of 1,675 positive samples from 13,439 patients obtained over six years","volume":"71","author":"Kolopp-Sarda","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"2025082722113185000_15.5.e249630.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2003.10.001"},{"key":"2025082722113185000_15.5.e249630.5","first-page":"10","article-title":"Hepatitis B virus infection and extra-hepatic manifestations: a systemic disease","volume":"16","author":"Cacoub","year":"2021","journal-title":"Official journal of the American College of Gastroenterology| ACG"},{"key":"2025082722113185000_15.5.e249630.6","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1007\/s11901-018-0403-0","article-title":"Extrahepatic manifestations of chronic hepatitis B infection","volume":"17","author":"Virlogeux","year":"2018","journal-title":"Current Hepatology Reports"},{"key":"2025082722113185000_15.5.e249630.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2005.05.029"},{"key":"2025082722113185000_15.5.e249630.8","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.20643"},{"key":"2025082722113185000_15.5.e249630.9","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29800"},{"key":"2025082722113185000_15.5.e249630.10","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.dld.2016.03.018","article-title":"Hepatitis B virus related cryoglobulinemic vasculitis: a multicentre open label study from the Gruppo Italiano di Studio delle Crioglobulinemie \u2013 GISC","volume":"48","author":"Mazzaro","year":"2016","journal-title":"Digestive and Liver Disease"},{"key":"2025082722113185000_15.5.e249630.11","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1111\/nep.12795","article-title":"Clinical and morphologic spectrum of renal involvement in patients with HBV-associated cryoglobulinaemia","volume":"22","author":"Li","year":"2017","journal-title":"Nephrology"},{"key":"2025082722113185000_15.5.e249630.12","doi-asserted-by":"crossref","first-page":"911","DOI":"10.7326\/0003-4819-149-12-200812160-00018","article-title":"Remission of hepatitis B virus-related cryoglobulinemic vasculitis with entecavir","volume":"149","author":"Kawakami","year":"2008","journal-title":"Ann Intern Med"},{"key":"2025082722113185000_15.5.e249630.13","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.dld.2016.03.018","article-title":"Hepatitis B virus related cryoglobulinemic vasculitis: A multicentre open label study from the Gruppo Italiano di Studio delle Crioglobulinemie - GISC","volume":"48","author":"Mazzaro","year":"2016","journal-title":"Dig Liver Dis"},{"key":"2025082722113185000_15.5.e249630.14","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1111\/joim.12913","article-title":"Hepatitis B virus-related cryogobulinemic vasculitis. 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