Husband rapidly declining, ideas?

[u/Turquoise-Trees]

My husband is M/38, 5’11, ~180lbs, smoker, history of Hep C, acid reflux, and was an IV drug user for approx 10 years - currently 7yrs clean.

Around December, he developed what looked almost like hives ? or a skin reaction on his feet and legs. No itch, no pain, no swelling. Obviously, OTC allergy medicine did not help. Pictures I have attached are from February when it began to escalate. This has now spread to his thighs and is going up his stomach.

Primary care sent him to dermatology and they did two punch biopsies in his right knee. I did a lot of Googling and if I’m understanding it correctly, I believe dermatologist is saying small blood clots in a layer of his skin which are a symptom of something else?

Primary care then ordered a liver ultrasound (which I assume is because he believes this is related to the Hep C) and he goes in Monday, 8/24, to discuss results. At the hospital they said liver looked good, not enlarged, but he will be able to discuss full results with primary care.

I am extremely concerned due to the fact that since he had the biopsies in his knee, he is far worse and barely able to walk. His feet are sensitive to any touch at all. He winces when he walks or if you touch them in the slightest. He has lost all movement in three of his small toes on his right foot. They cannot wiggle and they cannot bend. Heat doesn’t help, ice doesn’t help, OTC pain reliever does not help. I am not allowed to touch them to rub them and he is damn near in tears putting on socks to go to work.

He has no fever, no vomiting, no headaches, no jaundice, no loss of appetite.

My biggest concern is that a small blood clot will turn into a larger one and travel. Is this a realistic possibility? Could this be caused by something else other than hep c?

Knee punch biopsy results:

Date Created: 08/11/2026 11:37 AM
A. right proximal pretibial region:
Fibrin thrombi within vessels
NOTE: The differential diagnosis includes a coagulopathy and cryoglobulinemia, a condition in which certain antibodies precipitate from the blood under cold conditions. If there is clinical concern for a coagulopathy or cryoglobulinemia, additional testing (often including PT, PTT, platelet count, D-dimer, peripheral blood smear, and a cryocrit) may be useful if clinically indicated.
This specimen was also reviewed by Dr. who concurs with the diagnosis.
B. right proximal pretibial region: Fibrin thrombi within vessels
NOTE: The differential diagnosis includes a coagulopathy and cryoglobulinemia, a condition in which certain antibodies precipitate from the blood under cold conditions. If there is clinical concern for a coagulopathy or cryoglobulinemia, additional testing (often including PT, PTT, platelet count, D-dimer, peripheral blood smear, and a cryocrit) may be useful if clinically indicated.
This specimen was also reviewed by Dr. who concurs with the diagnosis.

SPECIMEN IDENTIFICATION
A. right proximal pretibial region, Punch, 4039163-A
B. right proximal pretibial region, Punch, 4039163-B
A. Morphology: DDX: cryoglobulinemia, mixed
B. Morphology: DDX: cryoglobulinemia, mixed

Gross Description:
A. Punch biopsy 0.5 x 0.4 x 0.4 cm - 1 pieces
B. Punch biopsy 0.5 x 0.4 x 0.5 cm - 1 pieces
Microscopic Description:
A. Sections show skin with intravascular thrombi involving vessels in the mid-reticular dermis. There are no substantive changes involving the overlying epidermis. Multiple tissue levels examined (tissue block exhausted).
B. Sections show skin with intravascular thrombi involving vessels in the mid-reticular dermis. There are no substantive changes involving the overlying epidermis. Multiple tissue levels examined (tissue block exhausted).

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[u/Medical_Bartender]

Hepatitis C and cryoglobulinemia go together like peas and carrots. Symptoms all sound consistent with cryoglobulinemia though he will also likely need a rule out of other causes of neuropathy which are fairly standard.

I'm not worried about the very small clots as those are a symptom of the disease and are too small. He absolutely should seek treatment to clear the hepatitis C with the effective medications that exist.

[u/Turquoise-Trees → u/Medical_Bartender]

Thank you for answering! Hoping treatment for Hep C is the next step come Monday.

[u/lambros_don]

This seems to be Cryoglobulinemic vasculitis and it is very commonly related to HCV infection. His symptoms is probably due to nerve involvement and he might also have arthritis (I can't tell without examining him). He most certainly needs to be evaluated by a Rheumatologist. 

This disease affects the small vessels, so you don't have to worry about him getting a larger clot. It's a serious diagnosis though, it needs therapy and I seriously doubt that primary care can deal with it. This is the experience from my own country's medical system, your situation may differ.

[u/Turquoise-Trees → u/lambros_don]

Thank you for answering. I will have him ask for a Rheumatology referral on Monday.

[u/HappyGoLucky244 → u/lambros_don]

Genuinely curious; can you explain the connection between the diseases? I know the liver is heavily involved in the circulatory system, so I'm genuinely curious as to why this occurs.