A role for chronic hepatitis C virus infection in a patient with cutaneous vasculitis, cryoglobulinemia, and chronic liver disease
- 29 Downloads
A six-year history of repeated attacks of fatigue, fever, arthralgias, skin changes, Raynaud's phenomenon, and neuropathy is reported in a patient with chronic liver disease. The following diagnoses were made: (1) leukocytoclastic vasculitis; (2) acute urticaria; (3) cryoglobulinemia type II with Raynaud's phenomenon and low serum level of C4; (4) peripheral polyneuropathy; (5) sicca syndrome; and (6) chronic hepatitis C virus infection. Despite therapy with corticosteroids symptoms increased gradually over years. In the first PCR of the nested PCR analysis, HCV-RNA was exclusively detected in the cryoglobulin fraction but not in the serum supernatant, suggesting that antibodies bind HCV particles, forming circulating immune complexes. As diagnoses 1-5 are well-known organ manifestations of cryoglobulinemia, we speculated whether treatment of hepatitis C with IFN-μ (3 million IU IFN-μ2b three times a week) would inhibit HCV replication, decrease the cryocrit level and thereby ameliorate organ manifestations such as neuropathy and vasculities. During treatment with IFN-μ only a very weak or no signal could be detected for HCV-RNA in the cryoglobulin fraction as well as in the serum supernatant. This held true also for the serum supernatant in the second PCR. In parallel, cryoglobulin level, immunoglobulins, and liver enzymes decreased substantially to normal or near normal levels. Clinical symptoms—leukocytoclastic vasculitis and neuropathy—disappeared. We conclude that chronic HCV infection is involved in the pathogenesis of cryoglobulinemia and that IFN-μ might be an effective treatment in these patients.
Key wordshepatitis C vasculitis cryoglobulinemia interferon-α
Unable to display preview. Download preview PDF.
- 1.Alter MJ, Margolis HS, Krawczynski K, Judson FN, Mares A, Alexander WJ, Hu PY, Miller JK, Gerber MA, Sampliner RE, Meeks EL, Beach MJ, for the Sentinel Counties Chronic Non-A, Non-B Hepatitis Study Team: The natural history of community-acquired hepatitis C in the United States. N Engl J Med 327:1899–1905, 1992PubMedGoogle Scholar
- 2.Seeff LB, Buskell-Bales Z, Wright EC, Durako SJ, Alter HJ, Iber FL, Hollinger FB, Gitnick G, Knodell RG, Perrillo RP, Stevens CE, Hollingsworth CG, National Heart Lung, and Blood Institute Study Group: Long-term mortality after transfusion-associated non-A, non-B hepatitis. N Engl J Med 327:1906–1911, 1992PubMedGoogle Scholar
- 4.Casato M, Taliani G, Pucillo LP, Goffredo F, Lagana B, Bonomo L: Cryoglobulinemia and hepatitis C virus. Lancet 337:1047–1048, 1991Google Scholar
- 9.Durand JM, Lefevre P, Harle JR, Boucrat J, Vitvitski L, Soubeyrand J: Cutaneous vasculitis and cryoglobulinemia type II associated with hepatitis C virus infection. Lancet 337:499–500, 1991Google Scholar
- 10.Hearth-Holmes M, Zahranka SL, Beathge BA, Wolf RE: Leukoklastic vasculitis associated with hepatitis C. Am J Med 90:765–766, 1991Google Scholar
- 23.Margin S, Craxi A, Di Marco V, Lolacono O, Fabiano C, Diquattro O, Fiorentino G, Marino L, Simonetti R, Almasio P, Wilber J, Urdea M, Neuwald P, Pagliaro L: Hepatitis C viremia in chronic liver disease: Response to corticosteroids and alpha-interferon. J Hepatol 18(suppl 1):S51, 1993 (abstract)Google Scholar