[HCV-associated cryoglobulinemic vasculitis]

To analyze clinical and laboratory features of cryoglobulinemic vasculitis (CGEV) associated with HCV infection.

We examined 61 patients with clinical manifestation of CGEV in 2006-2011. CGEV was associated with autoimmune diseases in 31 patients (51%), with HCV infection in 21 patients (34.4%), essential (idiopathic) ctyoglobulinemia in 8 patients (13%) and lymphoproliferative diseases in 1 patient (1.6%). 21 patients with HCV-associated CGEV were studied for main clinical and laboratory manifestations of the disease. Kidney and liver involvement was confirmed morphologically and immunomorphologically. Electroneurophysiological investigation evaluated peripheral nervous system involvement. Biopsy of parotid, lacrimal glands., peripheral lymph nodes, splenectomy and bone marrow trephine biopsy with morphological study and immunohistochemistry were used to identify type of lymphoma. Characteristics of monoclonal secretion were assessed with high-resolution electrophoresis in agarose gel with subsequent immunofixation of sera and concentrated urine.

Liver involvement was detected in 66% of patients with HCV-associated CGEV 34% patients were chronic HCV carriers with persistently normal liver function tests. Common rheumatologic manifestations of HCV-associated CGEV were skin lesions (90%), arthralgia (85%), frequent peripheral nervous system involvement (52%) and glomerulonephritis (38%). Prevalent immunological markers of CGEV associated with HCV were mixed monoclonal cryoglobulinemia with rheumatoid factor activity (62%), rare polyclonal (34%) and olygoclonal (4%) cryoglobulinemia, low levels of C4 compliment fraction (80%). Patients with mixed monoclonal cryoglobulinemia often developed clinical manifestations of Sjögren's syndrome (23%) and malignant lymphoproliferative diseases (14%). CGEV is a prognostically adverse sign in HCV infected patients and caused death of 14% patients even in a short period of follow-up (1-2 years).