Ankle edema

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