HCV related severe cryoglobulinemic vasculitis treated with plasma exchange and rituximab: case report and literature review

Mixed cryoglobulinemia is the most prevalent extrahepatic manifestation of chronic HCV infection. It is usually a benign lymphoproliferative disorder which presents as vasculitis affecting different organs. Although life-threatening cryoglobulinemic vasculitis (CryoVas) is rare, it is sometimes the...

Full description

Saved in:
Bibliographic Details
Main Authors: Snezana Arandjelovic, Branka Bonaci-Nikolic, Aleksandra Peric-Popadic, Vesna Tomic-Spiric, Jasna Bolpacic, Sanvila Raskovic, Sladjana Andrejevic
Format: Article
Language:English
Published: The Journal of Infection in Developing Countries 2017-06-01
Series:Journal of Infection in Developing Countries
Subjects:
Online Access:https://jidc.org/index.php/journal/article/view/8290
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Mixed cryoglobulinemia is the most prevalent extrahepatic manifestation of chronic HCV infection. It is usually a benign lymphoproliferative disorder which presents as vasculitis affecting different organs. Although life-threatening cryoglobulinemic vasculitis (CryoVas) is rare, it is sometimes the first and possibly lethal complication. Its treatment depends on the severity of vasculitis and can be challenging. High dose of corticosteroids, immunosuppressive agents and plasma exchange represent the first-line treatment, which should be followed by antiviral therapy. Rituximab is an effective and safe treatment option. However, the data about its use in life-threatening conditions are scarce. We report the case of a patient with severe, relapsing and life-threatening HCV-related CryoVas  resistant to standard therapy who had had an initial beneficial response to rituximab added to plasma exchange that was later compromised by the development of sepsis. We also review the literature and discuss manifestations and therapy of life-threatening Cryovas with focus on rituximab use.
ISSN:1972-2680