Cold Agglutinin Disease: Symptoms and Connections to Neuropathy

Numbness and tingling in the hands and feet associated with cryoglobulinemia?

Hello, doctor.
I was diagnosed with COVID-19 for the first time in early June this year and recovered.
At the end of June, I noticed similar bleeding spots on both feet and visited the hospital, where the doctor diagnosed me with vasculitis.
After taking steroids for two weeks, I recovered.
In July, I followed up with some immunological tests and found that my cryoglobulin was positive for IgM (1+) and RF IgM was 13.92.
In October, I had another follow-up, and the results showed cryoglobulin IgM (1+)/IgG (1+) and RF IgM 12.8.
Currently, when I am in an air-conditioned room, I feel that my fingers are colder.
Recently, I have also experienced occasional tingling sensations in my skin or slight numbness in a few fingers, as well as some soreness in my upper and lower arms.
Sometimes, the muscles in my arms twitch.
These symptoms may appear one day and disappear the next.
They sometimes occur on the left side and sometimes on the right side.
However, I have a history of cervical (MRI examination) and lumbar (X-ray examination) disc compression issues that have existed for eight to nine years, but previously, the symptoms were mostly on the left side and not frequent.
They have only recently become more frequent, and now I also have symptoms on the right side.
Therefore, I would like to ask if these abnormal sensations or soreness are caused by my existing cervical issues, or could they be related to cryoglobulinemia, or possibly associated with polyneuropathy?

Zhe, 40~49 year old female. Ask Date: 2023/11/11

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
To determine whether it is a neurological issue, including polyneuropathy, you can consult a neurologist.
They will assess whether further nerve conduction studies are necessary.
This test can help initially differentiate between polyneuropathy, cervical compression, or other neurological symptoms caused by conditions such as vasculitis, including cryoglobulinemia.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is here to assist you.

Reply Date: 2023/11/11

More Info

Cold Agglutinin Disease (CAD) is a type of autoimmune hemolytic anemia where the body produces antibodies that cause red blood cells to clump together (agglutinate) in response to cold temperatures. This condition can lead to various symptoms, including fatigue, weakness, and in some cases, neuropathic symptoms. Understanding the connections between CAD and neuropathy is crucial, especially in the context of your recent health issues following a COVID-19 infection.

After your COVID-19 diagnosis, you experienced symptoms that led to a diagnosis of vasculitis, which was treated with corticosteroids. The subsequent discovery of positive cold agglutinin levels and rheumatoid factor (RF) indicates an ongoing autoimmune process. Cold agglutinins can lead to a range of symptoms, particularly when exposed to cold environments, as you noted with your fingers feeling colder in air-conditioned spaces.

Neuropathy, or nerve damage, can manifest in various ways, including tingling, numbness, and pain. The symptoms you described—tingling sensations, occasional numbness in your fingers, and muscle twitching—can indeed be associated with neuropathy. In your case, the presence of cold agglutinins could potentially contribute to these symptoms. Cold agglutinin disease can lead to microvascular complications, where small blood vessels are affected, potentially causing ischemia (reduced blood flow) to peripheral nerves. This ischemia can result in neuropathic symptoms.

Moreover, your history of cervical and lumbar disc issues complicates the picture. Disc herniation or degeneration can lead to nerve root compression, which may cause similar symptoms to those seen in neuropathy. The fact that your symptoms have shifted from predominantly left-sided to also involving the right side suggests that there may be multiple factors at play. It is possible that both your existing cervical spine issues and the cold agglutinin disease are contributing to your symptoms.

To differentiate between these potential causes, a thorough evaluation by a neurologist is recommended. They may suggest nerve conduction studies and electromyography (EMG) to assess the function of your nerves and muscles. These tests can help determine if there is a neuropathic process occurring, whether due to cold agglutinin disease, cervical spine issues, or possibly even a condition like multifocal neuropathy.

In summary, your symptoms could be a result of several interconnected factors, including cold agglutinin disease, pre-existing cervical spine issues, and possibly multifocal neuropathy. It is essential to work closely with your healthcare provider to monitor your symptoms and adjust your treatment plan accordingly. Regular follow-ups and possibly additional diagnostic testing will help clarify the underlying causes of your symptoms and guide appropriate management strategies.

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