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Logo of aicSpringerOpen.comThis journalSubmit a manuscriptRegisterSpringerOpen.comAnnals of Intensive Care
 
Ann Intensive Care. 2012; 2: 31.
Published online Jul 19, 2012. doi:  10.1186/2110-5820-2-31
PMCID: PMC3488028
Vasculitic emergencies in the intensive care unit: a special focus on cryoglobulinemic vasculitis
Mohamad Zaidan,1 Eric Mariotte,1 Lionel Galicier,2 Bertrand Arnulf,3 Véronique Meignin,4 Jérôme Vérine,4 Alfred Mahr,5 and Élie Azoulaycorresponding author1,6
1Department of Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
2Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
3Department of Immuno-Hematology, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
4Department of Pathology, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
5Department of Internal Medicine, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
6AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France
corresponding authorCorresponding author.
Mohamad Zaidan: mohamad.zaidan/at/hotmail.fr; Eric Mariotte: eric.mariotte/at/sls.aphp.fr; Lionel Galicier: lionel.galicier/at/sls.aphp.fr; Bertrand Arnulf: bertrand.arnulf/at/sls.aphp.fr; Véronique Meignin: veronique.meignin/at/sls.aphp.fr; Jérôme Vérine: jerome.verine/at/sls.aphp.fr; Alfred Mahr: alfred.mahr/at/sls.aphp.fr; Élie Azoulay: elie.azoulay/at/sls.aphp.fr
Received May 27, 2012; Accepted June 24, 2012.
Abstract
Vasculitis is characterized by the infiltration of vessel walls by inflammatory leukocytes with reactive damage and subsequent loss of vessel integrity. The clinical course of systemic vasculitis may be punctuated by acute life-threatening manifestations that require intensive care unit (ICU) admission. Furthermore, the diagnosis may be established in the ICU after admission for a severe inaugural symptom, mostly acute respiratory failure. Among the systemic vasculitides, cryoglobulinemic vasculitis (CV) has been rarely studied in an ICU setting. Severe CV-related complications may involve the kidneys, lungs, heart, gut, and/or central nervous system. The diagnosis of CV in the ICU may be delayed or completely unrecognized. A high level of suspicion is critical to obtain a timely and accurate diagnosis and to initiate appropriate treatment. We describe severe acute manifestations of CV based on six selected patients admitted to our ICU. That all six patients survived suggests the benefit of prompt ICU admission of patients with severe CV.
Keywords: Cryoglobulinemia, Cryoglobulinemic vasculitis, Acute respiratory failure, Acute kidney injury, Vasculitis, Systemic disease
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