Cryoglobulinemic vasculitis

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Cryoglobulinemic vasculitis is a systemic vasculitis.

It can present with psychiatric features such as depression, anxiety, mood disturbance, cognitive dysfunction, behavioural change, and, less commonly, psychosis.

Other characteristic features include peripheral neuropathy (particularly sensory neuropathy or mononeuritis multiplex), headache, and, less commonly, central nervous system manifestations such as seizures or cerebrovascular events. Distinctive features include immune-complex small-vessel vasculitis associated with circulating cryoglobulins, often presenting with palpable purpura, arthralgia, weakness, and hypocomplementaemia. Associated conditions may include chronic hepatitis C infection and B-cell lymphoproliferative disorders.

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Renal/electrolytes: membranoproliferative glomerulonephritis with haematuria, proteinuria, hypertension, and impaired renal function may occur.

  • Hematologic: association with B-cell lymphoproliferative disorders (particularly lymphoplasmacytic lymphoma/Waldenström macroglobulinemia in monoclonal cryoglobulinemia) may occur; laboratory findings may include low complement levels, particularly reduced C4 in mixed cryoglobulinemia.

  • Musculoskeletal: arthralgia, myalgia, and weakness are common features.

  • Dermatologic: palpable purpura, livedo reticularis, ulcers, and other cutaneous vasculitic manifestations may occur.

  • Hepatobiliary: chronic hepatitis C infection is a common associated condition and may contribute to the development of mixed cryoglobulinemia.

Early diagnosis is important to identify and treat the underlying driver (such as hepatitis C infection or B-cell lymphoproliferative disease), enable appropriate immunomodulatory therapy, prevent irreversible organ damage (particularly renal and neurological complications), reduce vasculitic complications, and improve long-term prognosis and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.