Hepatitis B-Related Cryoglobulinemia: A Case Report of Renal-Pulmonary Syndrome
Bibliographic record
Abstract
Introduction: The World Health Organization estimates that approximately 296 million individuals were chronically infected with hepatitis B in 2019, with an annual incidence of 1.5 million new infections. Hepatitis B infection can lead to severe hepatic complications, including cirrhosis, liver failure and hepatocellular carcinoma. Rarely, patients with hepatitis B infection will develop extrahepatic manifestations such as mixed cryoglobulinemia. Case Description: 47-year-old man with untreated chronic hepatitis B (HBeAg negative) presented with hypoxia, pleuritic chest pain, hemoptysis, and pitting edema. He was noted to have a new normocytic anemia and a stage III AKI with proteinuria and hematuria on urine sediment. A CT pulmonary angiogram showed bilateral pleural effusion, pulmonary nodules and no evidence of embolism. Patient subsequently decompensated requiring intubation due to diffuse alveolar hemorrhage confirmed on bronchoscopy. His kidney biopsy was consistent with cryoglobulinemic glomerulonephritis and serum cryoglobulin testing was positive for mixed cryoglobulinemia. Patient was treated with intravenous pulse corticosteroids and started on entecavir. He responded well to the treatment and was successfully extubated. Following his course of intravenous corticosteroids, he was transitioned to high-dose oral prednisone once daily. His renal function returned to baseline and patient was discharged from hospital with outpatient follow-up. Discussion: This highlighted a case of HBV-related cryoglobulinemia with renopulmonary syndrome. Cryoglobulinemia is rarely seen in patients with hepatitis B infection and does not commonly lead to diffuse alveolar hemorrhage. Current guidelines recommend treatment for hepatitis B infection if there is evidence of liver injury either through elevated ALT or liver biopsy. The guidelines favor treating chronic hepatitis B infection with evidence of extrahepatic manifestations, however there are no recommendations on how to effectively screen patients. Diffuse alveolar hemorrhage is a life-threatening complication, and physicians should consider a lower threshold to treat patients with chronic hepatitis B infection. Given the rarity of HBV-related cryoglobulinemia with renopulmonary syndrome, there are no definitive guidelines on management; existing literature suggest treating with antiviral and corticosteroids, which was effective in this case.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".