Polyarteritis nodosa and cryoglobulinemic glomerulonephritis related to chronic hepatitis C.
METHODS
A 53-year-old man with hepatitis C virus (HCV) infection underwent cholecystectomy for presumed cholecystitis. Gallstones were not present, and histological examination demonstrated medium-sized arteritis, consistent with polyarteritis nodosa (PAN). The patient later developed rapidly progressive glomerulonephritis. Kidney biopsy demonstrated cryoglobulinemic glomerulonephritis. Because of the severity of the patient's vasculitic manifestations, treatment included pulse methylprednisolone followed by oral prednisone and monthly intravenous cyclophosphamide for 6 months. During treatment, microhematuria resolved, proteinuria decreased, and serum creatinine concentration stabilized. The patient subsequently underwent treatment for HCV with interferon resulting in a marked decrease in HCV RNA. The patient has had no relapse of his vasculitis, his renal function is stable, and viral load remains low after completing 36 weeks of interferon.


CONCLUSIONS
Life-threatening vasculitis related to HCV was successfully treated with immunosuppressive therapy. After obtaining clinical remission, antiviral therapy was instituted, resulting in a dramatic decrease in HCV RNA.
Canada
Robert
R
University of Tennessee Health Science Center, Memphis, Tennessee, USA. rcanada@utmem.edu
Chaudry
Sufiyan
S
Gaber
Lillian
L
Waters
Bradford
B
Martinez
Antonio
A
Wall
Barry
B
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D003449:Cryoglobulinemia / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D003520:Cyclophosphamide / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005921:Glomerulonephritis / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007372:Interferons / Q000008:administration & dosage; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D011241:Prednisone / Q000008:administration & dosage; D012720:Severity of Illness Index; D019562:Viral Load
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D007372:Interferons; D011241:Prednisone; D008775:Methylprednisolone