Abstract
Background. Hepatitis C is a global major health problem with extremely variable extrahepatic manifestations. Mixed cryoglobulinaemia (MC) shows a striking association with hepatitis C virus (HCV) infection, and it is sometimes asymptomatic. The skin is a frequently involved target organ in MC. Objective. To investigate the prevalence of cryoglobulinaemia in a sample of Egyptian patients with cutaneous manifestations of chronic HCV infection and to correlate its presence with clinical criteria and liver function tests. Methods. One hundred and eighteen patients with skin manifestations of chronic compensated hepatitis C were included. Venous blood was tested for liver function tests and serum cryoglobulins. Results. Twelve patients (10.169%) were positive for serum cryoglobulins (2 with pruritus, 4 with vasculitic lesions, 3 with livedo reticularis, one with oral lichen, one with chronic urticaria, and another with Schamberg's disease). Vasculitic lesions and livedo reticularis of the legs showed higher prevalence in cryoglobulin-positive than in cryoglobulin-negative patients. Presence of serum cryoglobulins did not relate to patients' demographic or laboratory findings. Conclusions. Fortunately, MC is not markedly prevalent among Egyptians with cutaneous lesions of chronic hepatitis C, and cryopositivity was commonly, but not exclusively, detected with cutaneous vasculitis and livedo reticularis. Laboratory testing for cryoglobulins in every HCV patient is advisable for earlier MC detection and management.
Highlights
Chronic hepatitis C virus (HCV) infection is a major public health problem that affects approximately 300 million people worldwide
A previous meta-analysis showed that 44% patients with chronic HCV infection had circulating immune complexes with cryoprecipitating properties [14], and it has been previously reported that the skin is the most frequently involved target organ in Mixed cryoglobulinaemia (MC) [15]
It is noticeable that more than half of the detected cryopositive patients had dermatological manifestations of HCV which were suggestive for cryoglobulinaemia (33.3% of cryopositive patients had vasculitic lesions on lower limbs and 25% had livedo reticularis), several patients were positive for serum cryoglobulins even in the absence of a clear clinical picture suggestive of autoimmune small vascular illness (16.6% of cryopositive patients were associated with intractable pruritus, 8.3% with oral erosive lichen planus, 8.3% with chronic urticaria, and 8.3% with Schamberg’s disease)
Summary
Chronic hepatitis C virus (HCV) infection is a major public health problem that affects approximately 300 million people worldwide. 40–75% of patients infected with HCV might develop at least one extrahepatic manifestation during the course of the disease, and sometimes these could represent the first and sole signal of HCV infection [3]. To investigate the prevalence of cryoglobulinaemia in a sample of Egyptian patients with cutaneous manifestations of chronic HCV infection and to correlate its presence with clinical criteria and liver function tests. Twelve patients (10.169%) were positive for serum cryoglobulins (2 with pruritus, 4 with vasculitic lesions, 3 with livedo reticularis, one with oral lichen, one with chronic urticaria, and another with Schamberg’s disease). Laboratory testing for cryoglobulins in every HCV patient is advisable for earlier MC detection and management
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