Try your hand at this medical mystery, which is followed by some didactics on a fascinating disease which will hopefully make sense of this inscrutable title.

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• Intro :22
• What to expect in each episode :30
• The case: A 75-year-old man with Sjogren’s and MALT lymphoma presents with recurrent cerebral infarcts of multiple territories 1:10
  • Rheumatology is consulted 6:11
  • Decreased sensation in toes occurs between strokes 7:14
  • What’s going on with this patient? 8:36
  • What additional labs can we perform? 9:36
  • We spin the urine 11:10
  • What kind of vasculitis are Sjogren’s and lymphoma associated with? 12:22
  • C3 and C4 had already been performed 13:00
  • An overall picture of this patient 13:54
  • What about the strokes? 14:19
  • Should we do more imaging? 15:57
  • At this point we can make a clinical decision 16:33
  • Why make a decision so quickly vs. waiting for biopsy? 18:18
  • Two things you must check before moving forward with a cryoglobulinemic vasculitis 19:46
  • Spoiler alert: The patient is doing really well 20:16

Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com.

• What is cryoglobulinemic vasculitis? 21:00
• What are these immunoglobulins? There are three types of cryoglobulins 22:55
• Usually driven by another identifiable disease 25:18
• What is making these immunoglobulins? 26:49
• We don’t know why these immunoglobulins behave this way 27:18
• How do you explain the kidneys? 28:28
• What’s occurring at the tissue level? 29:35
• How does type 1 present? 30:50
• Type 2 and type 3 31:12
• What other organ systems are involved? 33:11
• I hope you enjoyed this patient presentation 36:00
• What we’ll discuss in episodes 2 and 3 36:05
• Thanks for listening 38:03

**Coming soon from Healio, Unmasking COVID-19, a podcast hosted by Gitanjali Pai, MD, infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma. In this timely new show, Dr. Pai will explore COVID-19’s impact on vulnerable patient populations by answering questions from experts in various medical fields, including oncology, endocrinology and rheumatology. To submit your question for Dr. Pai, email covid19podcast@healio.com.**

We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum @LCalabreseDO @CCalabreseDO

Disclosure: Brown reports no relevant financial disclosures.

References:

Fuentes A, et al. Current Rheumatology Reports. 2019;21:60.

Silva F, et al. J Autoimmun. 2019;105:102313.