Mixed Cryoglobulinemia as a Potential Indicator of Clinically Silent Hepatitis C Infection

Authors

DOI:

https://doi.org/10.46570/utjms-2024-800

Keywords:

Cryoglobulinemia, chronic liver disease, vasculitis, Hepatitis C

Abstract

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. DOI: https://doi.org/10.1016/bs.acc.2020.09.006

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. DOI: https://doi.org/10.1186/s13075-022-02857-z

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. DOI: https://doi.org/10.1002/art.1780361003

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. DOI: https://doi.org/10.1186/s41927-020-00159-y

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. DOI: https://doi.org/10.1016/j.jdcr.2021.03.026

Ramos-Casals, M., J.H. Stone, M.C. Cid, and X. Bosch, The cryoglobulinaemias. Lancet, 2012. 379(9813): p. 348-60. DOI: https://doi.org/10.1016/S0140-6736(11)60242-0

Ferri, C., Mixed cryoglobulinemia. Orphanet J Rare Dis, 2008. 3: p. 25. DOI: https://doi.org/10.1186/1750-1172-3-25

Ferri, C., A.L. Zignego, and S.A. Pileri, Cryoglobulins. J Clin Pathol, 2002. 55(1): p. 4-13. DOI: https://doi.org/10.1136/jcp.55.1.4

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. DOI: https://doi.org/10.1002/ajh.24745

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. DOI: https://doi.org/10.1002/hep.28753

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. DOI: https://doi.org/10.1016/j.semarthrit.2014.10.004

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. DOI: https://doi.org/10.1053/j.ajkd.2012.08.040

Kirkpatrick, G., T. Winstone, P. Wilcox, and S. Van Eeden, Pulmonary hemorrhage in cryoglobulinemia. Can Respir J, 2015. 22(1): p. 13-5. DOI: https://doi.org/10.1155/2015/203410

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. DOI: https://doi.org/10.1615/CritRevEukaryotGeneExpr.2017018953

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. DOI: https://doi.org/10.1016/0016-5085(94)90022-1

Muchtar, E., H. Magen, and M.A. Gertz, How I treat cryoglobulinemia. Blood, 2017. 129(3): p. 289-298. DOI: https://doi.org/10.1182/blood-2016-09-719773

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. DOI: https://doi.org/10.1016/0190-9622(91)70168-2

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). DOI: https://doi.org/10.3390/diseases6020035

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. DOI: https://doi.org/10.1136/ard.2002.004929

Downloads

Published

2024-09-18

How to Cite

Islam, A., Haider, S., Tabassum, S., & Naeem, A. (2024). Mixed Cryoglobulinemia as a Potential Indicator of Clinically Silent Hepatitis C Infection. Translation: The University of Toledo Journal of Medical Sciences, 13(1). https://doi.org/10.46570/utjms-2024-800

Issue

Vol. 13 No. 1 (2024)

Section

Case Reports

License

Copyright (c) 2024 Asif Islam, MD; Salar Haider, MD; Shehroze Tabassum, MD; Aroma Naeem, MD;

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).