CRYOGLOBULINEMIA AND CUTANEOUS LEUKOCYTOCLASTIC VASCULITIS WITH HEPATITIS-C VIRUS-INFECTION

Background. Mixed cryoglobulinemia (MC) is a systemic disorder, charac terized by a typical clinical triad: purpura, weakness, and arthralgia s, with visceral complications such as liver and renal involvement. Th e objective was to study the association between hepatitis C virus (HC V) infection and essential mixed cryoglobulinemia (EMC). Patients and Methods. Markers of HCV infection in 11 pa tients with cryoglobulinemi a were examined and hepatitis C virus (HCV) was detected in eight of t hem. These patients were included in a clinical and histologic study. Anti-HCV antibodies were determined by a second-generation enzyme-link ed immunosorbent assay (ELISA-2) in sera and cryoprecipitates. Studies on HCV-RNA were performed by a two-stage polymerase chain reaction (P CR) in the serum. A control group, consisting of 28 patients with othe r cutaneous disorders, was studied for HCV infection using ELISA-2 and PCR. Results. All patients had liver dysfunction, arthralgias, and pu rpura. Three patients had involvement of the peripheral nervous system , two had renal involvement, and one patient had Sjogren's syndrome. C ryocrits ranged from 3% to 20%. Six patients had type III cryoglobulin emia and the remaining two had type II. Markers for hepatitis B virus (HSV) were negative in all serum samples. Anti-HCV antibodies and HCV- RNA were positive in the serum of all the cases with MC. Anti-HCV anti bodies were positive in all cases except for one of the cryoprecipitat es tested. Four patients received recombinant interferon alfa. In two of them, serum aminotransferases became normal and cryoglobulins disap peared. Conclusions. The results strongly suggest that HCV infection i s responsible for the cryoglobulinemia and vasculitis in patients with MC and that treatment with interferon alfa is presently the treatment of choice for such patients.