Mixed Cryoglobulinemia as a Potential Indicator of Clinically Silent Hepatitis C Infection
DOI:
https://doi.org/10.46570/utjms-2024-800Keywords:
Cryoglobulinemia, chronic liver disease, vasculitis, Hepatitis CAbstract
Hepatitis C virus (HCV) is one of the major causes of chronic liver disease and its prevalence is increasing worldwide. There are many extra hepatic manifestations of Hepatitis C infection including B –cell lymphoproliferative disorders. Mixed cryoglobulinemia (MC) is the most common prototype of B-cell lymphoproliferative disorders. Cryoglobulinemia is an immune complex mediated disease causing multi organ damage with vasculitis being the primary manifestation. We report a case of 50 years old Asian lady having clinically silent chronic liver disease secondary to hepatitis C who presented to us with a purpuric skin rash, joint pains and fatigue. She was confirmed to be a case of mixed cryoglobulinemia. Patient was prescribed direct antiviral agents and prednisolone which improved her condition to a great extent. Heightened awareness of cutaneous manifestations of MC associated with HCV might improve the detection rate of clinically silent HCV infection.
References
Napodano, C., F. Gulli, G.L. Rapaccini, M. Marino, and U. Basile, Cryoglobulins: Identification, classification, and novel biomarkers of mysterious proteins. Adv Clin Chem, 2021. 104: p. 299-340.
Roubertou, Y., S. Mainbourg, A. Hot, D. Fouque, C. Confavreux, R. Chapurlat, S. Debarbieux, D. Jullien, P. Sève, L. Juillard, M.N. Kolopp-Sarda, and J.C. Lega, Cryoglobulinemia in systemic lupus erythematosus: a retrospective study of 213 patients. Arthritis Res Ther, 2022. 24(1): p. 167.
Abel, G., Q.X. Zhang, and V. Agnello, Hepatitis C virus infection in type II mixed cryoglobulinemia. Arthritis Rheum, 1993. 36(10): p. 1341-9.
Alfraji, N., V.D. Upadhyaya, C. Bekampis, and H. Kuzyshyn, Mixed Cryoglobulinemia Syndrome (MCS) due to untreated hepatitis B with uncommon presentation: case report and literature review. BMC Rheumatol, 2020. 4(1): p. 58.
Runge, J.S., T.L. Pearson, D.F. Keren, S.D. Gitlin, E. Campagnaro, L. Lowe, J.E. Gudjonsson, and A.C. Hristov, Multiple myeloma presenting as cryoglobulinemic vasculitis. JAAD Case Rep, 2021. 11: p. 81-83.
Ramos-Casals, M., J.H. Stone, M.C. Cid, and X. Bosch, The cryoglobulinaemias. Lancet, 2012. 379(9813): p. 348-60.
Ferri, C., Mixed cryoglobulinemia. Orphanet J Rare Dis, 2008. 3: p. 25.
Ferri, C., A.L. Zignego, and S.A. Pileri, Cryoglobulins. J Clin Pathol, 2002. 55(1): p. 4-13.
Edgerton, C.C. Cryoglobulinemia Workup; Laboratory studies. 2023 28 April 2023; Available from: https://emedicine.medscape.com/article/329255-workup.
Sidana, S., S.V. Rajkumar, A. Dispenzieri, M.Q. Lacy, M.A. Gertz, F.K. Buadi, S.R. Hayman, D. Dingli, P. Kapoor, W.I. Gonsalves, R.S. Go, Y.L. Hwa, N. Leung, A.L. Fonder, M.A. Hobbs, S.R. Zeldenrust, S.J. Russell, J.A. Lust, R.A. Kyle, and S.K. Kumar, Clinical presentation and outcomes of patients with type 1 monoclonal cryoglobulinemia. Am J Hematol, 2017. 92(7): p. 668-673.
Gragnani, L., M. Visentini, E. Fognani, T. Urraro, A. De Santis, L. Petraccia, M. Perez, G. Ceccotti, S. Colantuono, M. Mitrevski, C. Stasi, M. Del Padre, M. Monti, E. Gianni, A. Pulsoni, M. Fiorilli, M. Casato, and A.L. Zignego, Prospective study of guideline-tailored therapy with direct-acting antivirals for hepatitis C virus-associated mixed cryoglobulinemia. Hepatology, 2016. 64(5): p. 1473-1482.
Giuggioli, D., A. Manfredi, F. Lumetti, M. Sebastiani, and C. Ferri, Cryoglobulinemic vasculitis and skin ulcers. Our therapeutic strategy and review of the literature. Semin Arthritis Rheum, 2015. 44(5): p. 518-526.
Fabrizi, F., E. Plaisier, D. Saadoun, P. Martin, P. Messa, and P. Cacoub, Hepatitis C virus infection, mixed cryoglobulinemia, and kidney disease. Am J Kidney Dis, 2013. 61(4): p. 623-37.
Kirkpatrick, G., T. Winstone, P. Wilcox, and S. Van Eeden, Pulmonary hemorrhage in cryoglobulinemia. Can Respir J, 2015. 22(1): p. 13-5.
Filippini, D., F. Colombo, S. Jann, R. Cornero, and B. Canesi, [Central nervous system involvement in patients with HCV-related cryoglobulinemia: literature review and a case report]. Reumatismo, 2002. 54(2): p. 150-5.
Arshad, A. and U.A. Ashfaq, Epidemiology of Hepatitis C Infection in Pakistan: Current Estimate and Major Risk Factors. Crit Rev Eukaryot Gene Expr, 2017. 27(1): p. 63-77.
Lunel, F., L. Musset, P. Cacoub, L. Frangeul, P. Cresta, M. Perrin, P. Grippon, C. Hoang, D. Valla, J.C. Piette, and et al., Cryoglobulinemia in chronic liver diseases: role of hepatitis C virus and liver damage. Gastroenterology, 1994. 106(5): p. 1291-300.
Muchtar, E., H. Magen, and M.A. Gertz, How I treat cryoglobulinemia. Blood, 2017. 129(3): p. 289-298.
Cohen, S.J., M.R. Pittelkow, and W.P. Su, Cutaneous manifestations of cryoglobulinemia: clinical and histopathologic study of seventy-two patients. J Am Acad Dermatol, 1991. 25(1 Pt 1): p. 21-7.
Mazzaro, C., L. Dal Maso, E. Mauro, V. Gattei, M. Ghersetti, P. Bulian, G. Moratelli, G. Grassi, F. Zorat, and G. Pozzato, Survival and Prognostic Factors in Mixed Cryoglobulinemia: Data from 246 Cases. Diseases, 2018. 6(2).
Lamprecht, P., C. Lerin-Lozano, H. Merz, R.H. Dennin, A. Gause, J. Voswinkel, S.O. Peters, O. Gutzeit, A.C. Arlt, W. Solbach, and W.L. Gross, Rituximab induces remission in refractory HCV associated cryoglobulinaemic vasculitis. Ann Rheum Dis, 2003. 62(12): p. 1230-3.
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