title: Pruritus as a presenting symptom of chronic hepatitis C.
abstract: Pruritus is a common symptom in cholestatic liver disease but is rare in chronic hepatitis C. Eight patients with chronic hepatitis C and severe pruritus were compared with regard to biochemical, serological, and histological features to eight disease controls with primary biliary cirrhosis and seven with cirrhosis due to hepatitis C. Among those with severe pruritus associated with chronic hepatitis C, serum aminotransferases were raised in all, alkaline phosphatase in four, and gamma-glutamyl-transpeptidase levels in all except one. Serum cholylglycine levels were elevated in seven of eight patients. Liver biopsies showed moderate to severe fibrosis in all patients and cirrhosis in five. Compared to control subjects with cirrhosis due to hepatitis C but no pruritus, ductopenia, and cholestatic changes were prominent, although less so than in controls with primary biliary cirrhosis. Chronic hepatitis C with moderate to severe fibrosis may result in low-grade cholestasis with pruritus, possibly in association with bile duct disappearance.
authors.affiliation: Liver Diseases Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Chia
authors.forename: N V
authors.initials: NV
authors.lastname: Bergasa
authors.forename: D E
authors.initials: DE
authors.lastname: Kleiner
authors.forename: Z
authors.initials: Z
authors.lastname: Goodman
authors.forename: J H
authors.initials: JH
authors.lastname: Hoofnagle
authors.forename: A M
authors.initials: AM
authors.lastname: Di Bisceglie
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D002779:Cholestasis / Q000150:complications; D005260:Female; D006000:Glycocholic Acid / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008105:Liver Cirrhosis, Biliary / Q000150:complications; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000209:etiology* / Q000473:pathology; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D006000:Glycocholic Acid