Vasculitic syndromes in hepatitis C virus: A review.
Vasculitis is a remarkable presentation of the extrahepatic manifestations of HCV. According to the presence or absence of cryoglobulins it is subdivided into two main types: cryoglobulinemic vasculitis and non cryoglobulinemic vasculitis based on the attribution of vasculitis to serum cryoglobulins as a pathogenic factor. The attribution of cryoglobulinemia to HCV represents a success story in the history of immunology, microbiology, and clinical medicine. HCV can bind to and invade lymphocytes, consequently triggering an immune response through different mechanisms. The epidemiology of the disease is well described and the clinical picture describes cutaneous, pulmonary, musculoskeletal, neurological, renal, endocrine, gastrointestinal, hepatic and cardiovascular manifestations. It may also be associated with sicca symptoms, an increased risk of lymphoma and serious catastrophic events. The pathology is well characterized. A classification criteria of the syndrome that was validated in 2014 is discussed. Management of CV is decided according to the presence and severity of its clinical presentation. It is divided into asymptomatic, mild, moderate, severe and life threatening disease. Recently introduced direct antiviral agents are proving safe and effective in the management of cryoglobulinemic vasculitis, and it is advocated that the two types of vasculitis be given prioritization in the Egyptian mass campaign to eradicate HCV.
Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Cairo University, Egypt.
Gaafar
G
Ragab
Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Cairo University, Egypt.
Mohamed A
MA
Hussein
ANCA, antineutrophil cytoplasmic antibody; APS, antiphospholipid syndrome; BAL, bronchoalveolar lavage; CAPS, catastrophic antiphospholipid syndrome; CRP, C reactive protein; CTD, connective tissue disease; Cryoglobulins; DAA, direct acting antiviral drugs; Direct acting anti-HCV drugs; ESR, erythrocyte sedimentation rate; Extrahepatic manifestations vasculitis; GIT, gastrointestinal tract; HSP, Henoch-Schonlein Purpura; HUS, hemolytic uremic syndrome; Hepatitis C virus; IFN α, interferon alpha; IHD, ischemic heart disease; MOH, minister of health; MRI, magnetic resonance imaging; NHL, non Hodgkin lymphoma; PAN, polyarteritis nodosa; PCR, polymerase chain reaction; PFT, pulmonary function test; PN, peripheral neuropathy; RNA, ribonucleic acid; TIAs, transient ischemic attacks; TTP, thrombotic thrombocytopenic purpura