PURE RED-CELL APLASIA ASSOCIATED WITH HEPATITIS-C INFECTION

We report the case of a 34-year-old woman with recurrent pure red cell aplasia and evidence of hepatitis B and C infection, Review of the En glish literature identified 19 prior cases in which pure red cell apla sia was associated with hepatitis, This case is the first in which ser ologic evidence of hepatitis C infection was documented, This patient also had porphyria cutanea tarda and marked hepatic siderosis but no a ctive hepatitis or cirrhosis. Treatment with cyclophosphamide and pred nisone produced complete remission of the pure red cell aplasia, Eryth roid colony formation (colony-forming unit-erythroid and erythroid bur st-forming unit) was reduced in cultures of bone marrow obtained durin g relapse but was normal in remission marrow, However, addition of the patient serum, whether collected during relapse or remission, inhibit ed erythroid colony formation by her bone marrow. These observations, and the known extrahepatic immunologic manifestations of hepatitis C i nfection, suggest that the pure red cell aplasia occurred because of a n autoimmune mechanism provoked by the infection.