Related Experiment Videos
Systemic vasculitis in patients with hepatitis C
P Cacoub1, T Maisonobe, V Thibault
1Department of Internal Medicine, H pital La Pitié-Salpêtrière, Paris, France. patrice.cacoub@psl.ap-hop-paris.fr
Insights
Hepatitis C virus (HCV) infection can cause different types of vasculitis, including polyarteritis nodosa (PAN) and mixed cryoglobulinemia (MC). Distinguishing between PAN-type and MC-type vasculitis is crucial for effective treatment strategies in HCV patients.
Area of Science:
- Hepatology
- Rheumatology
- Immunology
Background:
- Hepatitis C virus (HCV) infection is a known cause of systemic vasculitis.
- Two distinct patterns of vasculitis associated with HCV include polyarteritis nodosa (PAN) and mixed cryoglobulinemia (MC).
Purpose of the Study:
- To analyze the distinct clinical and pathological characteristics of patients with HCV-associated systemic vasculitis.
- To compare patients with PAN-type vasculitis versus MC-type vasculitis in the context of HCV infection.
Main Methods:
- Retrospective comparison of two groups of HCV patients with systemic vasculitis.
- Group 1: 10 patients with biopsy-proven PAN-type vasculitis.
- Group 2: 7 patients with MC syndrome.
Main Results:
- PAN-type vasculitis presented with life-threatening systemic involvement, severe neuropathies, malignant hypertension, and elevated inflammatory markers.
- MC-type vasculitis showed distinct features, including moderate sensory polyneuropathies and specific inflammatory cell infiltrates.
- Complete recovery was achieved in most PAN-type patients with combined therapy, while interferon-alpha was ineffective for peripheral neuropathy in MC-type patients.
Conclusions:
- HCV infection is associated with diverse systemic vasculitis syndromes, notably PAN and MC.
- Significant differences in clinical presentation, pathology, and therapeutic response necessitate differentiating PAN-type from MC-type vasculitis in HCV patients.
Objective:
To analyze the main characteristics of patients infected with hepatitis C virus (HCV) presenting with different types of vasculitis syndrome.
Methods:
We retrospectively compared 2 groups of patients with HCV presenting with systemic vasculitis: 10 with biopsy proven polyarteritis nodosa-type systemic vasculitis (PAN, Group 1) and 7 with mixed cryoglobulinemia syndrome (MC, Group 2).
Results:
Patients of Group 1 presented with different features than Group 2: life threatening systemic vasculitis (10 vs 0; p < 0.01), severe multifocal sensorimotor mononeuropathies versus distal moderate sensory polyneuropathies, malignant hypertension (5 vs 0; p = 0.04), cerebral angiitis (2 vs 0), ischemic abdominal pain (2 vs 0), kidney and liver microaneurisms (2 vs 0), increased erythrocyte sedimentation rate and C-reactive protein (7 vs 0; p < 0.01), renal insufficiency (5 vs 0; p = 0.04), HCV genotype 1b (3 vs 6; p = 0.06), and lower activity of chronic hepatitis (p = 0.02). Neuromuscular biopsies showed lesions of vasculitis in all patients, but the type of vasculitis was different in Group 1 compared to Group 2: medium size artery involvement (7 vs 0; p < 0.01), necrotizing vasculitis (10 vs 0; p < 0.01), and mononuclear cell infiltrate in perivascular areas (0 vs 7; p < 0.01). Using prednisone, plasma exchanges, and interferon-alpha, complete recovery was obtained in all PAN-type patients except one. In Group 2 patients, interferon-alpha did not have any effect on the peripheral neuropathy.
Conclusion:
HCV infection may be associated with different types of systemic vasculitis, i.e., polyarteritis nodosa or mixed cryoglobulinemia. Because of differences in clinical and pathological features and therapeutic strategy, PAN-type vasculitis should be distinguished from MC-type vasculitis in HCV patients.