The American Journal of Medicine
Volume 123, Issue 5 , Pages 400-408, May 2010

Management of Hepatitis C Virus-related Mixed Cryoglobulinemia

  • Francesco Iannuzzella, MD
    • ,
  • Augusto Vaglio, MD
    • ,
  • Giovanni Garini, MD

      Affiliations

    • Corresponding Author InformationRequests for reprints should be addressed to Giovanni Garini, MD, Department of Internal Medicine, Nephrology and Health Sciences, Ospedale Maggiore, Via A. Gramsci 14, Parma 43100, Italy

Department of Internal Medicine, Nephrology and Health Sciences, University of Parma Medical School, Parma, Italy

Abstract 

Mixed cryoglobulinemia is a chronic immune complex-mediated disease strongly associated with hepatitis C virus (HCV) infection. Mixed cryoglobulinemia is a vasculitis of small and medium-sized arteries and veins, due to the deposition of complexes of antigen, cryoglobulin and complement in the vessel walls. The main clinical features of mixed cryoglobulinemia vasculitis include the triad of palpable purpura, arthralgias, and weakness, and other pathological conditions such as glomerulonephritis, peripheral neuropathy, skin ulcers, and widespread vasculitis. The treatment of HCV-related mixed cryoglobulinemia is difficult due to the multifactorial origin and clinical polymorphism of the syndrome. It can be directed to eradicate the HCV infection, suppress the B-cell clonal expansion and cryoglobulin production, or ameliorate symptoms. The choice of the most appropriate treatment is strictly related to the assessment of disease activity, and to the extent and severity of organ involvement.

Keywords: Cryoglobulinemia, Hepatitis C virus (HCV), Interferon, Ribavirin, Rituximab

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 Funding: None.

 Conflict of Interest: None of the authors has any conflicts of interest associated with the work presented in this manuscript.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(10)00016-1

doi:10.1016/j.amjmed.2009.09.038

The American Journal of Medicine
Volume 123, Issue 5 , Pages 400-408, May 2010

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