title: Relapse of HCV Genotype 1b Infection After Sofosbuvir/Ledipasvir Treatment Presenting as De Novo Cryoglobulinemic Vasculitis.
abstract: Relapse of hepatitis C virus (HCV) genotype 1 infection after combination therapy with sofosbuvir and ledipasvir is unusual. We report a treatment-naïve, non-cirrhotic patient in whom the relapse of genotype 1b HCV infection was accompanied by de novo cryoglobulinemic vasculitis and glomerulonephritis, requiring hemodialysis for acute renal failure. Sequence analysis revealed several resistance-associated variants in the HCVNS5agene but not inNS3/4A. The patient's vasculitis was successfully treated with immunosuppression and plasmapheresis, followed by retreatment of HCV with a combination of sofosbuvir, simeprevir, and ribavirin. The patient achieved sustained virological response, recovered his renal function, and remains in remission from cryoglobulinemia.
authors.affiliation: Division of Internal Medicine, NorthShore University Health System, Evanston, IL.
authors.forename: Mohammad Qasim
authors.initials: MQ
authors.lastname: Khan
authors.affiliation: Division of Internal Medicine, NorthShore University Health System, Evanston, IL.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Moreno
authors.affiliation: Division of Pathology, NorthShore University Health System, Evanston, IL.
authors.forename: Nora
authors.initials: N
authors.lastname: Joseph
authors.affiliation: Division of Nephrology, NorthShore University Health System, Evanston, IL.
authors.forename: George
authors.initials: G
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, NorthShore University Health System, Evanston, IL.
authors.forename: Claus J
authors.initials: CJ
authors.lastname: Fimmel