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T12 and L1 vertebra, but no evidence of pulmonary embolism. Subsequent thrombophilic testing revealed the presence of cryoglobulin with positive lupus anticoagulant. The antinuclear antibody titer was negative. He was then treated with ribavirin and pegylated interferon, six cycles of plasmapheresis and oral anticoagulant. Viral load after 3 months was markedly improved with reduction of more than 97% (985429 IU/ml to 25329 IU/ml) and he was no longer dialysis-dependent. No further thrombotic events were reported. Conclusions: Hepatitis C-associated cryoglobulinemia and its three extra-hepatic manifestations have been described in this case, in other words, the renal, coronary and aortic involvement. Prompt recognition and intervention are keys to prevent the life-threatening complications. Collaboration between hepatologist and rheumatologist are crucial in formulating more efficacious strategy to address such condition in the future.