Hepatitis C, cryoglobulinemia, and cutaneous vasculitis associated with unusual and serious manifestations

Hepatitis C viral infection is currently the leading cause of chronic hepat itis and cirrhosis. It also is a major predisposing factor for the developm ent of hepatocellular carcinoma. It is estimated that approximately 1-2% of patients with hepatitis C infection have nonhepatic manifestations that ar e protean in nature. In this report, we describe six unusual cases of nonhe patic manifestations: abdominal vasculitis in two, peripheral neuropathy in two, and one patient each with central nervous system vasculitis and necro tizing cutaneous vasculitis. All patients had cutaneous vasculitis and cryo globulinemia. None of our patients had cirrhosis, yet three of the six pati ents died. Because of the severe manifestations, aggressive therapy was ins tituted with interferon, immunosuppressive medications, i.v. immunoglobulin , and plasmapheresis. Our report underscores the importance of recognizing nonhepatic manifestations in patients with hepatitis C infection that may b e associated with high morbidity and mortality.