HCV and cryoglobulinemic vasculitis.

Ferri, Clodoveo; Zignego, A.L.; Giuggioli, Dilia; Sebastiani, Marco; Cazzato, Massimiliano; Antonelli, Alessandro; Civita, L. La; Fadda, P.; Longombardo, G.; Pileri, Stefano

doi:10.3949/ccjm.69.suppl_2.sii20

Cited by 23 publications

(19 citation statements)

References 12 publications

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“…chronic active or persistent hepatitis most often due to HCV. 13,115 More than 50% of patients with HCV can be found to have mixed cryoglobulins, with a lesser frequency of vasculitis. 118 Indeed, most cases of essential mixed cryoglobulinemia reported in the literature have been established to be the consequence of HCV infection.…”

Section: Malignancy-induced Vasculitismentioning

confidence: 99%

“…114,115 Mixed cryoglobulins, composed of different immunoglobulins, with a monoclonal IgM rheumatoid factor component and polyclonal IgG in type II and polyclonal immunoglobulins IgM (with rheumatoid factor activity) and IgG in type III, are associated with connective tissue, hematologic malignancies, or infectious diseases, particularly hepatitis C infection (HCV). 116,117 (Type I cryoglobulins are monoclonal and typically produce hyaline thrombi rather than vasculitis.)…”

Section: Malignancy-induced Vasculitismentioning

confidence: 99%

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Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

Carlson

Kr²

2006

The American Journal of Dermatopathology

180

151

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A broad and diverse spectrum of vasculitic syndromes exists. These syndromes affect the skin with varying levels of associated systemic manifestations, running the gamut from a self-limited, localized, cutaneous phenomenon to rapidly progressive, multiorgan disease. The majority of cases of cutaneous vasculitis will show a neutrophilic small vessel vasculitis that can be either a primary (idiopathic) disorder (eg, cutaneous leukocytoclastic angiitis) or a secondary disorder that is associated with drugs, infection (eg, streptococcal infection, viral hepatitis), or underlying disease (eg, connective tissue disease, malignancy). Biopsy is the gold standard for the diagnosis of cutaneous vasculitis and also necessary for the detection of cutaneous vascular immune complexes by direct immunofluorescence. Based on the type of vessel disrupted by inflammation (small and/or muscular), the distribution of vasculitis in the dermis and subcutis, and predominate inflammatory cell-type mediating vessel wall damage, a list of relevant differential diagnoses can be generated. This histologic information coupled with extravascular findings such as tissue eosinophilia, tissue neutrophilia, and/or granulomas, plus pathophysiologic markers such as direct immunofluorescent examination for immune complexes and serologic evaluation for antineutrophil cytoplasmic antibodies allows for more accurate diagnosis of specific vasculitic entities. Herein, we review both primary and secondary vasculitic syndromes that affect the skin and show a small vessel neutrophilic mediated vasculitis.

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Section: Malignancy-induced Vasculitismentioning

confidence: 99%

Section: Malignancy-induced Vasculitismentioning

confidence: 99%

Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

Carlson

Kr²

2006

The American Journal of Dermatopathology

180

151

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“…29,30 There is no standard method to measure cryoglobulin. Histological examination in a cryoglobulinemic vasculitis patient reveals microvascular thrombus and leukocytoclastic vasculitis in the dermis.…”

Section: 33mentioning

confidence: 99%

“…Next, if cryoglobulin is positive, cryoglobulinemic vasculitis should be suspected and its underlying diseases sought, particularly hepatitis B, hepatitis C, systemic lupus erythematosus and Sjö gren's syndrome. [29][30][31] Third, direct immunofluorescence of the skin biopsy specimen is used to examine IgA deposition in the affected vessels. If we find IgA deposition in the vessels, especially small vessels in the dermis, HSP is indicated (Fig.…”

Section: Diagnostic Algorithm Of Primary Cutaneous Vasculitis (Kawakamentioning

confidence: 99%

New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

Kawakami

2010

The Journal of Dermatology

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Palpable purpura tends to indicate involvement of small vessel vasculitis in the upper dermis. Livedo racemosa, nodular lesion and skin ulceration are indicative of involvement of small to medium-sized vessel vasculitis in the lower dermis to subcutaneous fat. We set out to establish a new algorithm (KAWAKAMI algorithm) for primary cutaneous vasculitis based on the Chapel Hill Consensus Conference classification and our research results, and apply to the diagnosis. The first step is to measure serum antineutrophil cytoplasmic antibodies (ANCA) levels. If myeloperoxidase-ANCA is positive, Churg-Strauss syndrome or microscopic polyangiitis can be suspected, and if the patient is positive for proteinase 3-ANCA, Wegener's granulomatosis is most likely. Next, if cryoglobulin is positive, cryoglobulinemic vasculitis should be suspected. Third, if direct immunofluorescence of the skin biopsy specimen reveals immunoglobulin A deposition within the affected vessels, Henoch-Schö nlein purpura is indicated. Finally, the presence of anti-phosphatidylserine-prothrombin complex antibodies and ⁄ or lupus anticoagulant and histopathological necrotizing vasculitis in the upper to middle dermis (leukocytoclastic vasculitis) indicates cutaneous leukocytoclastic angiitis, whereas if necrotizing vasculitis exists in the lower dermis and ⁄ or is associated with the subcutaneous fat, cutaneous polyarteritis nodosa is indicated. The KAWAKAMI algorithm may allow us to refine our earlier diagnostic strategies and allow for efficacious treatment of primary cutaneous vasculitis. In cutaneous polyarteritis nodosa, warfarin or clopidogrel therapies should be administrated, and in cases that have associated active inflammatory lesions, corticosteroids or mizoribine (mycophenolate mofetil) therapy should be added. We further propose prophylactic treatment of renal complications in patients with Henoch-Schö nlein purpura.

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“…No treatment is able to cure all cases of mixed cryoglobulinemia [19], and the therapeutic strategy is not clearly defined. CS and immunosuppressive drugs are commonly used, but they stimulate virus replication and can accelerate the development of chronic liver hepatitis and cirrhosis, which, for HBV-PAN, facilitates the occurrence of liver cancer.…”

Section: Mixed Cryoglobulinemiamentioning

confidence: 99%

Advances in the Treatments of Systemic Vasculitides

Guillevin

2008

Clinic Rev Allerg Immunol

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Necrotizing systemic vasculitides are severe diseases in which prognosis improved since steroids and cytotoxic agents have been prescribed. The outcome is now better, and remission is obtained in more than 80% of patients. In this review paper, we will cover the indications of conventional treatments and new biotherapies and other therapies. The strategies that improve patient's outcome are discussed in the light of the prospective trials organized by international research groups.

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HCV and cryoglobulinemic vasculitis.

Cited by 23 publications

References 12 publications

Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

Cutaneous Vasculitis Update: Small Vessel Neutrophilic Vasculitis Syndromes

New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

Advances in the Treatments of Systemic Vasculitides

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