CHRONIC HEPATITIS-C, CRYOGLOBULINEMIA, AND CUTANEOUS NECROTIZING VASCULITIS - CLINICAL, PATHOLOGICAL, AND IMMUNOPATHOLOGIC STUDY OF 12 PATIENTS

Background: Several patients with chronic hepatitis C infection and cu taneous vasculitis have been described. Objective: The objective of th is study was to define better the features of necrotizing vasculitis a nd mixed cryoglobulinemia in patients with hepatitis C infection. Meth ods: A retrospective review of 611 patients with hepatitis C antibodie s was conducted. Patients with clinical and histopathologic findings o f cutaneous necrotizing vasculitis were identified. Clinical, histolog ic, and laboratory data were recorded. Results: Twelve patients with n ecrotizing vasculitis and chronic hepatitis C infection were identifie d. Palpable purpura was the most common clinical presentation. Onset o f skin lesions was usually more than 10 years after infection. The low er extremities were affected in all patients. Cryoglobulinemia of the mixed type II was present in 10 of 11 patients. Liver function tests w ere evaluated at the time of vasculitis in most of the patients. Rheum atoid factor was elevated in all nine patients tested. Total complemen t was decreased in seven of nine patients, and C4 was decreased in six of seven patients. Conclusion: Cutaneous vasculitis associated with c ryoglobulinemia and hypocomplementemia is not uncommon in the course o f chronic active hepatitis C infection. The triad of necrotizing vascu litis, chronic hepatitis C infection, and cryoglobulinemia occurs late after initial infection with hepatitis C. Antibodies to hepatitis C v irus should be determined in a patient with necrotizing vasculitis, es pecially if liver function tests are elevated.