title: A case of hepatitis C-associated osteosclerosis that was improved with the combination therapy of peginterferon alfa-2b and ribavirin.
abstract: Hepatitis C-associated osteosclerosis (HCAO) is a rare disorder characterized by a marked increase in skeletal mass in patients who are infected with hepatitis C virus (HCV). The clinical presentation is an acquired deep bone pain with increased serum alkaline phosphatase (ALP) activity. We present a case of a patient with HCAO who was treated with antiviral therapy. A 42-year-old Japanese man presented with severe, stabbing pain in his lower limbs. He was diagnosed with hepatitis C secondary to intravenous drug use 20 years earlier. Serum biochemical studies revealed markedly elevated ALP activity and osteocalcin levels. Skeletal radiographs showed diffuse bony sclerosis with marked cortical thickening in the long bones. The bony findings and clinical symptoms were attributed to HCAO. The HCV RNA viral load was high and the genotype was 2a. The patient was treated with peginterferon alfa-2b and ribavirin for 24 weeks. After 24 weeks of the combination therapy, the patient had a sustained virological response and clinical remission of bone pain and a decrease in the level of serum ALP. In conclusion, HCAO was improved by the combination therapy of peginterferon alfa-2b and ribavirin when the patient achieved sustained virological response. It was confirmed that HCAO was one of the extrahepatic manifestations of HCV.
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan. shakado@cis.fukuoka-u.ac.jp.|The Division of Advanced Clinical Research for Viral Hepatitis and Liver Cancer, Fukuoka University Faculty of Medicine, Fukuoka, Japan. shakado@cis.fukuoka-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shakado
authors.affiliation: Department of Endocrinology and Diabetes Mellitus, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Akehi
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Yotsumoto
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fukunaga
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Shizuka
authors.initials: S
authors.lastname: Kuno
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.|The Division of Advanced Clinical Research for Viral Hepatitis and Liver Cancer, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Sakurai
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Iwashita
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ueda
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Genryu
authors.initials: G
authors.lastname: Hirano
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Yokoyama
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.|The Division of Advanced Clinical Research for Viral Hepatitis and Liver Cancer, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morihara
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.|The Division of Advanced Clinical Research for Viral Hepatitis and Liver Cancer, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Nishizawa
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.|The Division of Advanced Clinical Research for Viral Hepatitis and Liver Cancer, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Sakamoto
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.|The Division of Advanced Clinical Research for Viral Hepatitis and Liver Cancer, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Anan
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Takeyama
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Irie
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Iwata
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sohda
authors.affiliation: Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan.|The Division of Advanced Clinical Research for Viral Hepatitis and Liver Cancer, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Sakisaka
keywords: Hepatitis C-associated osteosclerosis; Peginterferon alfa-2b; Ribavirin