Extrahepatic disease caused by hepatitis C? The development of multiple myeloma in a patient with chronic hepatitis C (CHC) – A case report

Abstract

An association between CHC and essential mixed cryoglobulinaemia and CLL has been suggested, however a causative role of hepatitis C virus (HCV) in these conditions has not been established. The authors report the case of a 50 year-old women with CHC followed-up since 1998 with high viral load (13.47 MEQ/ml), genotype 1b and moderately elevated liver function tests (LFTs). Laboratory data Liver biopsy revealed moderate activity (grade 5/18, stage I). In April 1999 one year interferon therapy (3×5 ME/week) was started. HCV RNA became negative along with the normalization of (LFTs), however the patient relapsed in the 7th month of treatment (HCV-RNA became positive, LFTs rose) and hypothyresosis developed. In September 2002 the patient was admitted with chronic back pain. CT examination demonstrated degenerative changes at the 5th lumbar vertebral body. In March 2003 the patient was again hospitalized with chronic back pain and weakness of the right lower limb. Multiple myeloma was diagnosed based on laboratory examination (We: 104mm/h, IgA: 18, IgG: 4186, IgM: 29 and M-component) and bone marrow biopsy (50% plasma cell infiltration). MRI revealed compression fracture of the 5th lumbar vertebral body and an abdominal mass in the right lower quadrant infiltrating the canalis spinalis, ileum and sacroilear joint. VAD treatment was started. In January 2004 after 6 courses of VAD therapy, the multiple myeloma is in remission. Although a pathogenic role of HCV infection in malignant lymphoproliferative disorders has not been established, the authors emphasize that extrahepatic manifestations may develop in several CHC patients supporting a role for complex follow-up in these patients.