A 69-year-old man presented with severe pain in hands and feet. The distal part of most fingers and toes were necrotic (Figure 1). Extensive diagnostic work-up was performed: physical examination was otherwise unremarkable, and a thoracic and abdominal CT-scan was non-contributive. Blood sampling demonstrated the presence of a type I cryoglobulinemia, constituted of a monoclonal immunoglobulin G kappa at a titer of 2.03 g/L. Bone marrow smear and biopsy were normal. Treatment with oral corticosteroids and rituximab was instituted, and necrotic lesions were surgically excised. Unfortunately, the patient was readmitted one month later for extension of digital necrosis and infectious pneumonia. Outcome was unfavorable and the patient died. Type I cryoglobulinemia represent 10 to 15% of all cryoglobulinemia . They are frequently associated with malignant B cell proliferation and the production of a precipitating monoclonal immunoglobulin that may result in severe ischemic manifestations such as the one reported here..