title: Hypertrophic cardiomyopathy secondary to hepatitis C virus-related vasculitis.
abstract: : Almost invariably associated with chronic HCV infection, cryoglobulinemic vasculitis is a small-vessel vasculitis commonly affecting the skin, kidneys, and peripheral nervous system. Cardiac involvement, possibly due to cardiac microcirculation involvement, is an utterly rare and severe complication. We describe a case of hypertrophic cardiomyopathy secondary to cryoglobulinemic vasculitis. Evaluation with transthoracic cardiac ultrasound and cardiac MRI evidenced severe left ventricular hypertrophy and diffuse hypokinesia, a marked decrease in left ventricular ejection fraction, and a subtle late enhancement of inferior and lateral left ventricular walls. Upon clinical stabilization, the patient received treatment with anti-CD20 monoclonal antibody rituximab. Clinical and radiological follow-up with cardiac ultrasound and cardiac MRI documented a dramatic and sustained clinical improvement, with marked reduction of left ventricular hypertrophy, resolution of late enhancement, recovery of left ventricular contractility and function.
authors: aDepartment of Internal Medicine and Clinical Immunology bDepartment of Cardiology cDepartment of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors: Giulio
authors: G
authors: Cavalli
authors: Alvise
authors: A
authors: Berti
authors: Gabriele
authors: G
authors: Fragasso
authors: Francesco
authors: F
authors: De Cobelli
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D003449:Cryoglobulinemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009200:Myocardial Contraction; D020127:Recovery of Function; D000069283:Rituximab / Q000627:therapeutic use; D016896:Treatment Outcome; D014657:Vasculitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D016277:Ventricular Function, Left
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D000069283:Rituximab