False-seronegative HCV infection motivated by interference with cryoglobulins release_lz2xm7oqszcvhbykz6gyqhvhvq

by Gemma Recio Comí, Carmen Molina Clavero, Sandra Calabuig Ballester, Clara Benavent Bofill, Ester Picó-Plana, Carla Martín Grau, Cristina Gutiérrez Fornés, Ma Teresa Sans Mateu

Published in Advances in Laboratory Medicine / Avances en Medicina de Laboratorio by Walter de Gruyter GmbH.

2021   Volume 2, Issue 2, p297-300

Abstract

<jats:title>Abstract</jats:title> <jats:sec id="j_almed-2020-0086_abs_001_w2aab3b7c19b1b6b1aab1c16b1Aa"> <jats:title>Objectives</jats:title> Cryoglobulins (CGs) are serum proteins that undergo a reverse cold-induced precipitation <jats:italic>in vitro</jats:italic>. The CGs are a well-known cause of analytical interferences in several laboratory tests, leading to spurious results. With this in view, we present a case of a patient initially misdiagnosed due to CGs interference in Hepatitis C Virus (HCV) serology. </jats:sec> <jats:sec id="j_almed-2020-0086_abs_002_w2aab3b7c19b1b6b1aab1c16b2Aa"> <jats:title>Case presentation</jats:title> We report a case of a woman of advanced age affected by acute renal failure that required urgent haemodialysis. In the absence of infections and other causes of CGs production, a diagnosis of acute renal failure secondary to essential cryoglobulinemia was established. However, an unexpected positive HCV viral load was encountered. At this point, a false-seronegative HCV infection conditioned to CGs interference <jats:italic>in vitro</jats:italic> was suspected, confirmed by repeating serology in pre-warmed serum. Finally, the patient was correctly diagnosed with HCV-secondary cryoglobulinemia. </jats:sec> <jats:sec id="j_almed-2020-0086_abs_003_w2aab3b7c19b1b6b1aab1c16b3Aa"> <jats:title>Conclusions</jats:title> As shown in the case, the presence of CGs in blood may represent a challenge for the correct interpretation of several laboratory tests. The identification of CGs and the pre-treatment of serum are decisive to avoid spurious results and reach a genuine diagnosis. </jats:sec>
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