[Chronic hepatitis C in type-II cryoglobulinemia and cutaneous vasculitis]

Over a period of 2 years recurrent erysipelas-like skin eruptions developed over both lower legs of a 77-year-old woman. On examination there was a vasculitic purpura which histologically was like leukocytoclastic vasculitis. Further tests revealed a positive rheuma factor, a mixed type II cryoglobulinaemia of monoclonal IgM-kappa paraprotein and polyclonal IgG, as well as chronic hepatitis C with viral replication and demonstration of hepatitis C virus-RNA in the cryoprecipitates, diagnostic of chronic hepatitis C with mixed type II cryoglobulinaemia. Treatment was begun with prednisone, 25 mg/d orally, and cyclophosphamide, 100 mg/d orally. Once hepatitis C had been diagnosed, treatment was continued with interferon alpha-2b (initially 3 x 5 mill. IU, later 3 x 3 mill. IU, each weekly subcutaneously). The vasculitis quickly healed and the cryoglobulinaemia had disappeared within 5 weeks. So far, during the treatment of 9 months, the vasculitis has not recurred, but cryoglobulins have again been demonstrated. The signs and symptoms of hepatitis C were not affected by the interferon treatment.