Hematologic Disorders

Essential mixed cryoglobulinemia. Essential mixed cryoglobulinemia (EMC) is a condition that results in the deposition of circulating immune complexes in small-to-medium blood vessels. Patients with EMC usually present with rash, arthralgias, and weakness. A review of the literature reveals that hepatitis C can be found in 95% of all patients with EMC.[49-52] Several investigators have suggested that hepatitis C may have a causative role in EMC. Anti-HCV antibodies can be detected in the vessel walls of skin biopsy specimens taken from patients with EMC and chronic vasculitis. Interferon (IFN) therapy has been shown to reduce the cryocrit and lead to symptomatic improvement of both rash and joint pains. The response is short-lived, however, because symptoms almost universally reappear on cessation of therapy.[53-57]

Lymphoma. Several reports have described an increased incidence of B-cell lymphoma in patients with hepatitis C. Rasul and colleagues[58] studied 16 patients with chronic hepatitis C and cryoglobulinemia for the presence of lymphoma. Bone marrow biopsy results were consistent with non-Hodgkin's lymphoma in 2 patients and suspicious for lymphoma in 7. Although this finding needs to be evaluated further in larger studies, the development of lymphadenopathy or unexplained chronic anemia in a patient with hepatitis C infection should raise concern about the possibility of underlying lymphoma.

Renal Disorders

Glomerulonephritis has been associated with hepatitis C.[59,60] Patients are noted to have proteinuria, which can be significant and in the nephrotic range. Most cases of glomerulonephritis are associated with cryoglobulinemia. The most common histologic lesion seen is membranoproliferative glomerulonephritis. IFN therapy may reduce proteinuria, but a sustained response is seldom achieved in these patients.[61,62] Ribavirin should be avoided in patients with significant renal impairment. Some patients may benefit from the use of plasmapheresis, although the relief tends to be short-lived.[63]

Several dermatologic disorders have been described in association with hepatitis C. These include porphyria cutanea tarda (PCT) and lichen planus.[45]

Porphyria cutanea tarda. PCT is the most common form of porphyria. PCT has been associated with hepatitis C infection, particularly in those patients with significant alcohol use.[47,64,65] Hepatitis C may be found in 58% to 71% of PCT patients. PCT tends to present at an earlier age in patients with hepatitis C than in those without HCV infection. Despite this association, the clinical changes seen in PCT do not appear to be a direct consequence of viral infection.

Lichen planus. Lichen planus lesions may be associated with prolonged hepatitis C infection. These lesions are most commonly seen in the oral mucocutaneous area, but can occur anywhere on the skin. This condition, which is immunologically mediated, may be worsened by interferon therapies.[45]

Endocrine Disorders

Hepatitis C has been associated with both diabetes mellitus and an increased incidence of antithyroid antibodies.

Diabetes mellitus. An association between hepatitis C and diabetes mellitus has recently been demonstrated.[66-68] Mason and colleagues[66] retrospectively evaluated 1117 patients with chronic hepatitis C and found this infection to be an independent predictor of diabetes. Mehta and associates[67] found that among individuals older than 40 years, those with hepatitis C infection were more than 3 times as likely to have type 2 diabetes mellitus as those without hepatitis C infection. The prevalence of type 1 diabetes was not increased. The link between these 2 disorders needs to be investigated further, because this may lead to an improvement in available therapies.

Update- DIABETES and HCV