Unusual course of the hepatitis C virus infection in one patient diagnosed of common variable immunodeficiency

Common variable immunodeficiency (CV1) is defined by low serum IgG and IgA levels, and it is the second most frequent primary immunodeficiency. The indication for treatment with human gammaglobulin in patients with this syndrome has been well established. Here we report a case history of a patient diagnosed of common variable immunodeficiency, and she had treatment with i.v. commercial gammaglobulin. In the course of the disease, she developed symptoms that make us think about the possibility of hepatitis virus infection. HBV-associated antigens and antibodies, and HCV-Ab were all negative. So, amplification of HCV-RNA by polymerase chain reaction (PCR) was performed, and it became positive in two different determinations. Liver failure got worse quickly and the patient died. About the course of the HCV infection, only 30% of patients with acute hepatitis get biochemical resolution, and 50-70% become carriers and have persistent chronic hepatitis or active chronic hepatitis. In this case, HCV infection showed an unusual acute and fatal course, it is possible that the impaired immune status of the patient could play a role in the acute course of the disease. Therefore, every patient who have intravenous immunoglobulin replacement must be monitored regularly for liver function tests, and by PCR for HCV infection.