Clinical relevance of cryoglobulinaemia and extrahepatic neurocutaneous manifestations of chronic hepatitis C

ABSTRACT

The association of hepatitis C virus [HCV] with the extrahepatic complications of cryoglobulinaemia is widely recognized. The aim of this research was to examine the prevalence of cryoglobulinaemia [Cg] in patients with chronic HCV infection and its relation to extrahepatic neuro-cutaneous manifestations. Forty patients [26 males and 14 females], with clinical, laboratory and histopathologically established chronic HCV, with a mean age of 37.5years were submitted to clinical examination with stress on stigmata of chronic liver disease, dermatological and neurological evaluation as well as neurophysiological evaluation, laboratory assessment including liver function tests, serum cryoprecipitate immunoelectrophoresis, and revision of histopathlogical findings. a high prevalence of Cg 62.5% in patients with chronic HCV infection, the presenting symptoms were fatigue [67.5%], artheralgia [32.5%], parathesia [30%] and pruritus [25%], however, there were no statistically significant difference between cryo +ve versus Cryo -ve patients except for pruritis, face pigmentation. Skin manifestations inclding face pigmentation [42.5%], leukocytoclastic vosculitis [LCV] [22.5%], Porphyria cutanea tarda [PCT] [20%], Lichen planus [17.5%], acral necrolytic erythema [15%] and vitiligo [15%]. Neurological manifestations including symptomatic neuropathy in 10%, neuropathic changes detected by nerve conduction velocity [NCV] and electromyography [EMG] in 30% and electroencephalographic changes in 22.5%. Interestingly, these cutaneous and neurological manifestations were significantly associated with the presence of cryoglobulinaemia. Liver histopathology of the studied patients according to METAVIR score [Activity] A0-3 [Fibrosis] F0-4 showed no statistically significant difference between cryo positive versus cryo negative patients. conclusion findings confirmed a clear association between cryoglobulianemia and extrahepatic neurocutaneous manifestations of HCV infection. The presence of these manifestations in the appropriate clinical setting should suggest the presence of HCV infection