American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the definitive treatment requirement for cryoglobulinemia secondary to hepatitis C?

1. Administration of glucocorticoids

2. Resolution of the hepatitis C infection

3. Plasmapheresis only

4. Connection to a nephrologist

The correct answer is: Resolution of the hepatitis C infection

The definitive treatment for cryoglobulinemia secondary to hepatitis C is the resolution of the hepatitis C infection. Cryoglobulinemia is often associated with chronic infections, notably hepatitis C, which stimulates the production of cryoglobulins—proteins that can precipitate in cooler temperatures and cause various symptoms such as vasculitis. Targeting the underlying cause— in this case, the hepatitis C virus— is essential for effectively managing cryoglobulinemia. Antiviral therapy aimed at achieving sustained virological response (SVR) significantly reduces the levels of these cryoglobulins, alleviating the symptoms of the associated condition. While glucocorticoids and plasmapheresis can be helpful for managing some symptoms or complications of cryoglobulinemia, they do not address the root cause, which is the hepatitis C infection. Engaging a nephrologist, while often beneficial in cases where kidney involvement occurs, does not provide a definitive treatment for cryoglobulinemia itself unless there are specific renal complications that require specialized management. Therefore, the most effective and definitive approach to treating cryoglobulinemia in this context is through the resolution of the hepatitis C infection.