Extrahepatic symptoms as presenting manifestations of hepatitis C virus infection

Extrahepatic manifestations are being recognized increasingly in patients w ith hepatitis C virus (HCV) chronic infection. The objective of this study is to investigate these extrahepatic symptoms as presenting manifestations of HCV chronic infection. We studied 189 patients with HCV chronic infection, demonstrated by the pre sence of viral RNA in the serum. The presenting symptoms as well as the pre sence of other extrahepatic manifestations were registered at the first con sultation by means of a clinical and laboratory protocol. In 47 patients (2 4.8%), Liver disease was previously undiagnosed and HCV infection manifeste d itself by extrahepatic symptoms. The mean age was older (p < 0.001), and there were more females (p < 0.001). However, the mean alanine aminotransfe rase value was lower (p < 0.001) compared with that of the patients who had been seen first for liver disease-related problems. Arthralgias (p < 0.001 ) and fibromyalgia (p = 0.022) were significantly more common among the pat ients seen first for extrahepatic manifestations. Other extrahepatic manife stations, such as sicca symptoms, arthritis, and purpura, were also common in these patients. Immunologic abnormalities were present in 70% of patient s. Extrahepatic symptoms were the initial manifestations of HCV chronic infect ion in 25% of our patients. We point out the importance of extrahepatic man ifestations as presenting symptoms of HCV infection.