Association between HCV induced mixed cryoglobulinemia and pulmonary affection: the role of TNF-alpha in the pathogenesis of pulmonary changes

Chronic hepatitis C virus [HCV] infection is associated with both pulmonary involvement and cryoglobulinemia. Therefore, this study was designed to investigate the relationship between pulmonary involvement and mixed cryoglobulinemia in chronic HCV infected patients and to investigate the role of TNF-alpha in the pathogenesis of pulmonary changes. After hospital ethics committee approval and formal patient consent were obtained, 100 patients with compensated hepatitis C virus infection as confirmed by PCR were recruited in this cross sectional study. Their demographic and laboratory data, abdominal ultrasound findings, pulmonary function tests [spirometry], arterial blood gas [ABG] parameters, TNF-alpha levels, and data from high-resolution chest CT were collected and analyzed using SPSS version 16, and a serum cryoglobulin assay was performed in all of the studied patients The prevalence of mixed cryoglobulinemia was 61.7% in the studied HCV patients. Pulmonary symptoms were observed in more than half of these patients. The most common complaint among the symptomatic patients was dyspnea [51.7%], followed by cough [43.3%]. Oxygen saturation [Spo[2] and Sao[2]%], and FEVi and FVC levels, were significantly decreased in the cryoglob-ulin positive patients compared to the cryoglobulin negative patients. A statistically significant correlation was found between the presence of cryoglobulins and FEV level, FVC level, serum albumin level, viremia level, thrombocytopenia and arterial blood gas parameters. No correlation was found between cryoglobulinemia and TNF-alpha level. The results of this study suggest that pulmonary involvement is common in patients with chronic HCV infection and mixed cryoglobulinemia. Cryoglobulinemia may lead to pulmonary involvement through vascular and interstitial deposition of cryoglobulins, which results in impaired gas exchange and airway affection

Joint affection in chronic active hepatitis c with correlation to liver biopsy and cryoglobulinemia

This study was carried out to map, in a cohort of consecutive patients with chronic HCV infection, joint affection with correlation to cryoglobulinemia and with viral activity detected through liver biopsy done for those patients. Thirty three patients with hepatitis C infection were recruited for the study. Laboratory investigations involved determination of erythrocyte sedimentation rate [ESR], IgM rheumatoid factor [RF] and its titer, serum aminotransferases, and alkaline phosphatase concentrations. Cryoglobulines detection was done in their blood. State of viral activity and degree of hepatic fibrosis were detected by doing liver biopsy through [Metavir score]. Thirty three hepatitis C patients [15 males and 18 females] with mean age [SD] 43.5 [10.5] with mean disease duration [SD] of 50.8 [24.1] months were recruited for the study. Three patients were found to fulfill at least 4 out of the 7 ACR classification criteria for rheumatoid arthritis. They were excluded from the study. There is highly significant strong positive correlation between arthritis and cryogolbulinemia. There is non significant week negative correlation between arthritis and Metavir score -A liver biopsy. There is significant difference between cryoglobulins-positive and -negative patients as regard arthritis. Rheumatological manifestations constitute part of the extra hepatic manifestations of hepatitis C infection, so that sector of patients may have criteria sufficient for RA classification. Cryoglobulinemia plays an important role in association of arthritis/arthralgia in HCV infection patients. HCV, Hepatitis C virus ; MC, mixed cryoglobulinemia ; ALT, alanine aminotransferase; RTPCR, reverse transcriptase-polymerase chain reaction ; RF, rheumatoid factor; RA rheumatoid arthritis; ACR, American College of Rheumatology; ESR, erythrocyte sedimentation rate; SD, slandered deviation

First report case of cryoglobulinemia and cryofibrinogenemia in Thailand.

A 43-year-old monk had generalized purpura, arthritis of both shoulders, erythrocyanosis of lip and oral mucous membrane, Raynaud's phenomenon and uveitis. Platelets were normal. Cryoglobulin and cryofibrinogen were positive. Biopsy revealed vasculitis. No underlying infection, collagen vascular disease, lymphoproliferative, myeloproliferative and malignancy were found. He was diagnosed as having essential cryoglobulinemia and cryofibrinogenemia.