Rheumatoid Arthritis Complicated with Mixed Cryoglobulinemia and Thrombotic Microangiopathy, Presenting as Extensive Cutaneous Thrombosis: A Rare Clinical Phenotype

Rheumatoid arthritis–associated mixed cryoglobulinemia is rare and may occasionally trigger severe thrombotic microangiopathy. We report a patient who developed acute hemolysis, thrombocytopenia, acute renal dysfunction, and extensive cutaneous thrombosis, creating a challenging diagnostic scenario of cryoglobulinemia-induced thrombotic microangiopathy (TMA). This unusual phenotype underscores the difficulty of differentiating overlapping TMA syndromes and highlights the importance of early immunosuppression and supportive therapy to prevent organ injury. The structured approach, from confirming systemic and dermatological involvement to identifying cryoglobulinemia and excluding infectious and prothrombotic causes, supported the diagnosis of TMA secondary to cryoglobulinemia.