title: Hepatectomy for hepatocellular carcinoma complicated by vasculitis flare.
abstract: BACKGROUND
  The hepatitis C virus is a major cause of hepatocellular carcinoma. Extrahepatic manifestations of hepatitis C include mixed cryoglobulinemia which can result in ischemic damage to multiple organs. The management of these sequelae in posthepatectomy patients is unclear.
  
  
  METHODS
  A 49-year-old male with hepatitis C was found to have a 4 cm hepatocellular carcinoma on surveillance imaging. He underwent portal vein embolization followed by hepatectomy. His postoperative course was complicated by the development of splenic infarcts, small bowel ischemia, skin lesions, and liver damage. Findings of elevated cryocrit and elevated rheumatoid factor suggested the diagnosis of cryoglobulin-related vasculitis. The patient improved on supportive care.
  
  
  CONCLUSIONS
  Cryoglobulinemia is associated with hepatitis C and may complicate the care of this patient population. The treatment of cryoglobulinemia posthepatectomy patients is complicated by concerns over how medications may affect the regenerating liver. Steroids should be used with caution in this setting.
  
  
  CONCLUSIONS
  Brief report of hepatectomy complicated by vasculitis in the context of hepatocellular carcinoma secondary to hepatitis C addresses the management of mixed cryoglobulinemia in post-hepatectomy patients.
authors.affiliation: New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Abdi
authors.forename: Svetlana
authors.initials: S
authors.lastname: Krasnokutsky
authors.forename: Amy
authors.initials: A
authors.lastname: Rapkiewicz
authors.forename: Amit
authors.initials: A
authors.lastname: Saxena
authors.forename: Gerald
authors.initials: G
authors.lastname: Villanueva
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D003449:Cryoglobulinemia / Q000209:etiology*; D006498:Hepatectomy; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014657:Vasculitis / Q000209:etiology*