Membranoproliferative Glomerulonephritis and Leukocytoclastic Vasculitis without Cryoglobulin in Chronic Hepatitis C Virus Infection

Abstract

The etiopathogenesis of extrahepatic manifestations including vasculitis in the context of HCVinfection is still unknown. Wereport a case with lethal extrahepatic manifestations due to chronic hepatitis C virus (HCV) infection. The patient presented leukocytoclastic vasculitis, sensorimotor neuropathy and membranoproliferative glomerulonephritis with positive rheumatoid factor but lacked cryoglobulin. Hypocomplementaemia and deposition of IgM and C3 in the vascular lesion and glomeruli suggested that immune complex disease played a role in the pathogenesis of extrahepatic manifestations independent of cryoglobulin. Although HCVwas successfully eliminated by treatment with interferon a, she died of cryptococcal infection.

Cutaneous Vasculitis With Undetectable Cryoglobulinemia in Chronic Hepatitis C

“…The finding of HCV in vascular endothelial cells suggests that antibodies or sensitized T cells may initiate the process. Membranoproliferative glomerulonephritis and leukocytoclastic vasculitis without cryoglobulin in chronic HCV infection has been reported previously 5 . In our patient, the intensive search for cryoglobulins was negative, but the elimination of virus has led to improvement of vasculitis.…”