Vnitr Lek 2005, 51(2):238-243

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

P. Husa^1,*, Z. Adam², L. Husová³, J. Feit⁴, M. Penka⁵, Z. Čermáková⁶

¹ Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Petr Husa, CSc.

² Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Vorlíček, CSc.

³ Interní gastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc.

⁴ Patologicko-anatomický ústav Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jirka Mačák, CSc.

⁵ Oddělení klinické hematologie FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Miroslav Penka, CSc.

⁶ Oddělení klinické biochemie a hematologie FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Milan Dastych, CSc.

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.

Keywords: chronic hepatitis C; mixed cryoglobulinaemia; pegylated interferon; ribavirin

Received: March 22, 2004; Accepted: April 23, 2004; Published: February 1, 2005  Show citation