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Hypertrophic cardiomyopathy secondary to hepatitis C virus-related vasculitis

Giulio Cavalli1, Alvise Berti, Gabriele Fragasso

  • 1aDepartment of Internal Medicine and Clinical Immunology bDepartment of Cardiology cDepartment of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|July 1, 2014
PubMed

Insights

Cryoglobulinemic vasculitis, linked to HCV infection, can rarely cause severe cardiac issues like hypertrophic cardiomyopathy. Treatment with rituximab led to significant recovery of heart function and structure.

Area of Science:

  • Cardiology
  • Rheumatology
  • Nephrology

Background:

  • Cryoglobulinemic vasculitis is a small-vessel vasculitis typically linked to chronic Hepatitis C Virus (HCV) infection.
  • It commonly affects the skin, kidneys, and peripheral nervous system.
  • Cardiac involvement is an exceptionally rare but severe complication.

Observation:

  • A case of hypertrophic cardiomyopathy secondary to cryoglobulinemic vasculitis is presented.
  • Cardiac imaging revealed severe left ventricular hypertrophy, diffuse hypokinesia, reduced ejection fraction, and subtle late gadolinium enhancement.
  • These findings suggest cardiac microcirculation involvement in cryoglobulinemic vasculitis.

Findings:

  • The patient was treated with the anti-CD20 monoclonal antibody rituximab.
  • Following treatment, significant clinical improvement was observed.
  • Cardiac ultrasound and MRI demonstrated a marked reduction in left ventricular hypertrophy and improved cardiac function.

Implications:

  • This case highlights rituximab as an effective treatment for cardiac manifestations of cryoglobulinemic vasculitis.
  • It underscores the importance of considering cardiac involvement in patients with cryoglobulinemic vasculitis.
  • Further research may elucidate the mechanisms of cardiac microcirculation involvement in this condition.

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