A 62-year-old male presents with a 3-month history of fatigue, arthralgia, and intermittent abdominal pain. On examination, the patient has bilateral ankle edema and palpable purpura on the lower legs. The patient has a history of chronic hepatitis C infection, which was diagnosed 10 years ago. He was treated with interferon and ribavirin therapy and achieved sustained virologic response. The patient also has a history of hypertension, which is well-controlled with Ramipril. Laboratory findings:
Serum creatinine……………………………………....….89 µmol/L (49–93)
Aspartate aminotransferase (AST)……………..52 IU/L (15–37)
Alanine aminotransferase (ALT)………………...44 IU/L (17–63)
Total bilirubin………………………………………......….24 µmol/L (3–17)
Hepatitis C viral load…………………….…..………..Undetectable
Rheumatoid factor…………………………..…….……Positive
Cryoglobulins………………………………….…...….….Present