Steroid-refractory chronic idiopathic thrombocytopenic purpura associated with hepatitis C virus infection.
OBJECTIVE
Hepatitis C virus infection has often been suggested as a possible cause of various kinds of autoimmune diseases. The aim of this study was to determine the relationship between chronic idiopathic thrombocytopenic purpura (ITP) and hepatitis C virus infection and to characterize the clinical features of anti-HCV antibody (HCVab) positive chronic ITP patients.


METHODS
We studied HCVab in 79 patients with chronic ITP (25 males, 54 females, mean age 42.3 yr, range 11-86 yr) using the third-generation ELISA method.


RESULTS
HCVab was detected in 11 of the 79 patients (13.9%). Quantitative HCV-RNA studies showed a high serum concentration of HCV-RNA in these patients. The platelet counts in these 11 HCVab-positive patients (Group 1) were lower than in the 68 HCVab-negative patients (Group 2) [(2.6 +/- 0.9) versus (4.9 +/- 3.0) x 10(10)/L, respectively; p<0.02]. Significantly more patients in Group 1 required prednisolone therapy (10/11, 90.9%) than in Group 2 (31/68, 45.6%) (P < 0.005). The response rate to prednisolone treatment was significantly higher in Group 2 (19/31, 61.3%) than in Group 1(0/10, 0%) (P < 0.001). There was no difference in the response to splenectomy between Groups 1 (4/7, 57.1%) and 2 (3/5, 60%).


CONCLUSIONS
Given these findings, we recommend that HCVab is measured upon diagnosis of chronic ITP, and that splenectomy is planned in patients with HCVab in the event that prednisolone treatment is ineffective.
Sakuraya
Masataka
M
Third Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Gunma 371-8514, Japan.
Murakami
Hirokazu
H
Uchiumi
Hideki
H
Hatsumi
Nahoko
N
Akiba
Tohoru
T
Yokohama
Akihiko
A
Matsushima
Takafumi
T
Tsukamoto
Norifumi
N
Morita
Kimio
K
Karasawa
Masamitsu
M
Ogawara
Hatsue
H
Nojima
Yoshihisa
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000601:surgery; D012367:RNA, Viral / Q000097:blood; D012074:Remission Induction; D013156:Splenectomy
D018937:Hepatitis C Antibodies; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D011239:Prednisolone