Interstitial lung fibrosis and rheumatic disorders in patients with hepatitis C virus infection.
A possible aetiopathogenetic role of hepatitis C virus (HCV) has been reported in various immune-mediated disorders, such as mixed cryoglobulinaemia, which may be complicated by interstitial lung involvement; moreover, different viruses, including HCV, have been correlated with idiopathic pulmonary fibrosis. Here, a cohort of eight HCV-positive patients (M/F = 4/4, mean age 61 +/- 8 S.D. yr) with interstitial lung fibrosis and a variable number of rheumatic disorders are described. Interstitial lung involvement appeared medially 4.5 +/- 3.2 S.D. yr after the clinical onset of chronic hepatitis. During the clinical follow-up, some rheumatic symptoms were also recorded: articular involvement (four patients): mild sicca syndrome (one patient); severe polymyositis and cranial neuropathy (one patient); serum cryoglobulins and/or autoantibodies (eight patients). In all patients, a moderate (four patients) or severe (four patients) lung fibrosis was evaluated by means of high-resolution computed tomography. The presence of parenchymal radiotracer uptake on 67Ga scan (7/7 patients) and increased percentages of neutrophils (4/4 patients) and lymphocytes (2/4) at bronchoalveolar lavage suggested an active lung involvement. Different degrees of reduction of single breath diffusing capacity for carbon monoxide (DLco) (mean value 57.6 +/- 15%, range 37-80) were observed in all cases, while spirometric abnormalities, consistent with a global restrictive pattern, were less frequently found. In all cases, anti-HCV antibodies and HCV viraemia were demonstrated: viral genome was also detected in peripheral lymphocytes from 4/4 subjects and in one case in lung biopsy specimens. A desquamative interstitial pneumonia pattern was demonstrated in two cases by lung biopsy. The present work supports the hypothesis that HCV chronic infection could represent a trigger factor for interstitial lung fibrosis and various rheumatic disorders.
Ferri
C
C
Rheumatology Unit, University of Pisa, Italy.
La Civita
L
L
Fazzi
P
P
Solfanelli
S
S
Lombardini
F
F
Begliomini
E
E
Monti
M
M
Longombardo
G
G
Pasero
G
G
Zignego
A L
AL
D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D004417:Dyspnea / Q000503:physiopathology; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000150:complications*; D008214:Lymphocytes / Q000821:virology; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000150:complications*; D012367:RNA, Viral / Q000097:blood; D012216:Rheumatic Diseases / Q000150:complications*; D012217:Rheumatoid Factor / Q000097:blood
D000914:Antibodies, Viral; D012367:RNA, Viral; D012217:Rheumatoid Factor