Primary cryoglobulinemia with cutaneous features

Cryoglobulinemia: A Rare Cause of Digital Gangrene After Elective Foot Surgery

The development of gangrene after elective digital surgery is a rare complication. We present a case of a patient with normal preoperative vascular examination findings and a history significant for untreated hepatitis C. The patient underwent revisional second toe arthrodesis and plantar plate repair with pin fixation. After surgery, she developed gangrene and ultimately required partial digital amputation. The wound at the amputation site worsened postoperatively, warranting a rheumatologic evaluation that revealed previously undiagnosed cryoglobulinemia. Cryoglobulinemia is defined as the presence of abnormal proteins in the blood that crystallize when cooled. It can cause systemic vasculitis and is often associated with hepatitis C infection. The hyperviscosity of the immunoglobulins and an intravascular inflammatory response can lead to thrombosis and ischemic tissue loss. In the absence of peripheral arterial disease, patients undergoing digital surgery who develop digital infarcts should be screened for cryoglobulinemia as a potential cause for digital necrosis, especially if the patient has a history of hepatitis C. We describe a case of an unusual presentation of gangrene after elective digital surgery and highlight the need for a rheumatologic evaluation in cases in which vasculitis is suspected.