[Herbal drugs mimicking primary biliary cirrhosis]. / Pflanzliche Präparate sind nicht immer harmlos...

A woman, who consumed the recommended daily doses of Relaxane® and Hova® over several months was found to have elevated liver enzymes. A liver biopsy showed histologic changes consistent with primary biliary cirrhosis. After stopping treatment with Relaxane® and Hova® we observed a decline of the increased liver enzymes to normal levels two months later. A second biopsy of the liver three months later showed a clear decline of the initial histologic changes.

[Hepatitis C infection with false negative serology in a patient with mixed cryoglobulinemic vasculitis]. / Hepatitis-C-Infektion mit falsch negativer Serologie bei gemischter kryoglobulinämischer Vaskulitis.

HISTORY AND ADMISSION FINDINGS: A 72-year-old man with nausea, fever and elevated inflammatory parameters was transferred for further diagnostic assessment and treatment. On examination a palpable purpura was obvious without any signs of infection. INVESTIGATIONS: Creatininekinase was 350 mmol/l with a proteinuria of 20 g per day. Histological examination revealed hypersensitivity vasculitis in the cutis and a membranoproliferative glomerulonephritis. In addition there was a mixed cryoglobulinemia with a negative test for hepatitis C virus. Further investigation revealed hepatitis C virus RNA genotype 1 b in the cryoprecipitate. DIAGNOSIS AND TREATMENT: The patient was successfully treated with with interferon alpha for 12 month. The nephrotic syndrome improved and the proteinuria ceased CONCLUSION: Mixed cryoglobulinemias are associated with hepatitis C virus infection in over 80% of cases. Normally it is easy to make the diagnosis serologically with an ELISA test. But in a few cases the virus RNA is only detectable in the cryoprecipitate. If there is a high suspicion of an hepatitis C infection with cryoglobulinemia but HCV serology is negative, it is essential that virus antigen and antibodies are searched for in the cryoprecipitate.