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Treatment of chronic infection with hepatitis C virus with pegylated interferon and ribavirin in patient with mixed cryoglobulinaemia


Authors: P. Husa 1;  Z. Adam 2;  L. Husová 3;  J. Feit 4;  M. Penka 5;  Z. Čermáková 6
Authors‘ workplace: Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Petr Husa, CSc. 1;  Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Vorlíček, CSc. 2;  Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc. 3;  Patologicko-anatomický ústav Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jirka Mačák, CSc. 4;  Oddělení klinické hematologie FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Miroslav Penka, CSc. 5;  Oddělení klinické biochemie a hematologie FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Milan Dastych, CSc. 6
Published in: Vnitř Lék 2005; 51(2): 238-243
Category: Case Reports

Overview

Mixed cryoglobulinaemia is the most common extrahepatic manifestation of hepatitis C virus (HCV) infection. Anti-HCV antibodies and ribonucleic acid of the virus, HCV RNA, can be detected in cryoprecipitates, together with rheumatoid factor. Cryoglobulins consist of complex of immunoglobulins that in vitro precipitate upon the cooling bellow the human body temperature. Vasculitis is caused by the deposition of such immunocomplexes in the small blood vessels. 36–45% of patients chronically infected with HCV have cryoglobulins in serum; however, less than 10% of them develop clinically manifested vasculitis. In the referred patient sporadic eruption of exanthema with urticaria pattern started to appear on both lower limbs concurrently with sole oedemas and migrating arthralgias in 1998. He was examined by a lot of specialists without the cause of exanthema being found. Only after 5 years chronic hepatitis C was diagnosed, infection with genotype 2 of the virus, and the relationship between skin manifestations belonging to the clinical picture of vasculitis associated with type 3 mixed cryoglobulinaemia and chronic HCV infection was found. Patient was treated for 24 weeks with pegylated interferon alpha-2a and ribavirin. During a treatment period HCV RNA disappeared from serum and skin findings became normal. This situation persists even 48 weeks after the end of the antiviral treatment.

Key words:
chronic hepatitis C – mixed cryoglobulinaemia – pegylated interferon – ribavirin


Sources

1. Agnello V, Chung RT, Kaplan LM. A role for hepatitis C virus infection in type II cryoglobulinemia. N Engl J Med 1992; 327(21): 1490–1495.

2. Cacoub P, Lidove O, Maisonobe T et al. Interferon-alpha and ribavirin treatment in patients with hepatitis C virusrelated systemic vasculitis. Arthritis and Rheumatism 2002; 46(12): 3317–3326.

3. Calleja JL, Albillos A, Moreno–Otero R et al. Sustained response to interferon–alpha or to interferon-alpha plus ribavirin in hepatitis C virus-associated symptomatic mixed cryoglobulinaemia. Aliment Pharmacol Ther 1999; 13(9): 1179–1186.

4. Cicardi M, Cesana B, Del Ninno E et al. Prevalence and risk factors for the presence of serum cryoglobulins in patients with chronic hepatitis C. J Viral Hepatol 2000; 7(2): 138–143.

5. Durand JM, Cacoub P, Lunel–Fabiani F et al. Ribavirin in hepatitis C related cryoglobulinemia. J Rheumatol 1998; 25(6): 1115–1117.

6. Ferri C, Marzo E, Longobardo G et al. Interferon-alpha in mixed cryoglobulinemia patients: a randomized, crossovercontrolled trial. Blood 1993; 81(5): 1132–1136.

7. Hoofnagle JH, Heller T. Hepatitis C. In: Zakim D, Boyer TD (eds). Hepatology. A Textbook of Liver Disease. 4th ed. Philadelphia: WB Saunders 2003; 1017–1062.

8. Ito A, Kazama T, Ito K et al. Purpura with cold urticaria in a patient wit hepatitis C virus infection-associated mixed cryoglobulinemia type III: successful treatment with interferon beta. J Dermatol 2003; 30(4): 321–325.

9. Lamprecht P, Lerin-Lozano C, Merz H et al. Rituximab induces remission in refractory HCV associated cryoglobulinaemic vasculitis. Ann Rheum Dis 2003; 62(12): 1230–1233.

10. Lunel F, Cacoub P. Treatment of autoimmune and extrahepatic manifestations of hepatitis C virus infection. J Hepatol 1999; 31(Suppl 1): 210–216.

11. Mazzaro C, Colle R, Baracetti S et al. Effectiveness of leukocyte interferon in patients affected by HCV–positive mixed cryoglobulinemia resistant to recombinant alpha–interferon. Clin Exper Rheumatol 2002; 20(1): 27–34.

12. Mazzaro C, Zorat F, Comar C et al. Interferon plus ribavirin in patients with hepatitis C virus positive mixed cryoglobulinemia resistant to interferon. J Rheumatol 2003; 30(8): 1775–1781.

13. Misiani R, Bellavita P, Fenili D et al. Hepatitis C virus infection in patients with essential mixed cryoglobulinemia. Ann Intern Med 1992; 117(7): 573–577.

14. Misiani R, Bellavita P, Fenili D et al. Interferon alfa-2a therapy in cryoglobulinemia associated with hepatitis C virus. N Engl J Med 1994; 330(11): 751–756.

15. Pascual M, Perrin L, Giostra E et al. Hepatitis C virus in patients with cryoglobulinemia type II. J Infect Dis 1990; 162(2): 569–570.

16. Pawlotsky JM, Ben Yahia M, Andre C et al. Immunological disorders in C virus chronic active hepatitis: a prospective case-control study. Hepatology 1994; 19(4): 841–848.

17. Schott P, Hartmann H, Ramadori G. Hepatitis C virus-associated mixed cryoglobulinemia. Clinical manifestations, histopathological changes, mechanism of cryoprecipitation and options of treatment. Histology and Histopathology 2001; 16(4): 1275–1285.

18. Zuckerman E, Keren D, Slobodin G et al. Treatment of refractory, symptomatic hepatitis C virus related mixed cryoglobulinemia with ribavirin and interferon-alpha. J Rheumatol 2000; 27(8):2172–2178.

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