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[Fibrosing alveolitis with hepatitis C-related cryoglobulinemia]
History And Admission Findings:
A 56-year-old man presented with fever, myalgia and weakness of the limbs for four weeks. The physical examination showed a skin rash, hepatomegaly and reduced mobility of the limbs due to pain.
Investigation:
Laboratory tests revealed an elevated rheumatoid factor, cryoglobulins and were positive for hepatitis C-antibodies. The lung function tests indicated mild obstruction and a moderate decrease of diffusion capacity. Bronchoalveolar lavage showed lymphocytic alveolitis. Computed tomography of the thorax revealed mediastinal lymphadenopathy, diffuse ground-glass infiltrates and bilateral signs of fibrosis in the lower lung fields.
Diagnosis, Treatment And Course:
Because of the fibrosing alveolitis associated with hepatitis C-related cryoglobulinemia, immunosuppression was started with high-dosage prednisone and azathioprine. The symptoms improved on this treatment.
Conclusion:
Hepatitis C-related cryoglobulinemia is a rare condition that usually presents with nonspecific symptoms. Severe pulmonary involvement is very uncommon. There are no general guidelines about treatment.
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