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Front Immunol 2021 25;12:580271. Epub 2021 Feb 25.

Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China.

This study aimed to describe the main characteristics of Chinese patients with cryoglobulinemia, especially the characteristics of patients with different causes of cryoglobulinemia. Eighty inpatients diagnosed with cryoglobulinemia from different wards in Peking Union Medical College Hospital were included in this study. Demographic, clinical, biological, and renal pathological data were collected. Read More

World J Gastroenterol 2021 Jan;27(1):19-36

Department of Pathology, National Cheng Kung University Hospital, Tainan 70403, Taiwan.

Human hepatitis viruses (HHVs) include hepatitis A virus, hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis delta virus, and hepatitis E virus and can cause liver inflammation in their common human host. Usually, HHV is rapidly cleared by the immune system, following acute HHV invasion. The morbidities associated with hepatitis A virus and hepatitis E virus infection occur shortly after their intrusion, in the acute stage. Read More

Cureus 2020 Dec 8;12(12):e11986. Epub 2020 Dec 8.

Internal Medicine, Jinnah Medical and Dental College, Karachi, PAK.

CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome, also known as the limited cutaneous form of systemic sclerosis (lcSSc), is a multisystem connective tissue disorder often manifesting as a consequence of superimposed autoimmune hepatitis. Herein, we present a case of a 40-year-old female with a past one-year history of hepatitis C presenting with the chief complaints of progressive thickness and tightness of the skin of hands and face and dysphagia for the past three months, along with arthralgia of the hands for the past two months, suggestive of CREST syndrome. Through this case, we intend to emphasize the association between extrahepatic manifestations and the emergence of autoantibodies in patients with hepatitis C virus (HCV) infection and discuss the clinical relevance of the autoantibodies in extrahepatic disorders, in our case, CREST syndrome. Read More

World J Hepatol 2020 Oct;12(10):841-849

Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Helwan University, Cairo 11795, Egypt.

Background: Hepatitis C virus (HCV) is a disease with a significant global impact, affecting approximately 2%-2.5% of the world's population. New direct-acting antivirals (DAAs) have been introduced over the past few years with great success in viral eradication. Read More

Curr Opin Rheumatol 2021 Jan;33(1):1-7

Immunogenomics and inflammation research Unit EA 4130, University of Lyon.

Purpose Of Review: Cryoglobulins (CG) are immunoglobulins that precipitate in the cold, and dissolve at 37°C. In vivo, in cold exposed tissues and organs, they can induce vasculitis and occlusive vasculopathy after deposition on vascular endothelium under low temperature and high concentration conditions. Clinical manifestations are cutaneous (purpura, ulcers, vasomotor symptoms, and livedo reticularis), rheumatological (arthralgia and arthritis), and peripheral neuropathy (paresthesia and pain in the lower limbs). Read More

Int J Low Extrem Wounds 2020 Oct 22:1534734620961893. Epub 2020 Oct 22.

Northern Illinois Foot and Ankle Specialists, Crystal Lake, IL, USA.

Cryoglobulinemia is an uncommon blood dyscrasia that can manifest itself in the lower extremity. Due to the insidious nature of this disease, dermatological symptoms and ulcerations can easily be mistaken for more common entities. The authors present an overview of cryoglobulinemia and a case report of a patient with lower extremity manifestations of this disorder. Read More

Dermatol Ther 2020 11 20;33(6):e14365. Epub 2020 Oct 20.

Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assuit University, Assuit, Egypt.

Egypt displays a high-hepatitis C virus (HCV) burden and almost 20% of the patients develop cutaneous manifestations HCV-related. Direct acting antivirals (DAAs) drastically changed HCV patient's morbidity and mortality but their impact of the cutaneous manifestations remains elusive. Our aim was to find out the prevalence of different dermatological manifestations accompaning HCV infection in Egyptian patients. Read More

Therap Adv Gastroenterol 2020 24;13:1756284820942617. Epub 2020 Jul 24.

Department of Internal Medicine and Clinical Immunology, Hôpital La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Cedex 13, Paris, France.

Hepatitis C virus (HCV) infection is responsible for both hepatic and extrahepatic manifestations. Before the era of direct-acting antivirals (DAA), cryoglobulinemia was related to HCV infection in 70-90% of cases. Observed in 30% to 40% of patients with hepatitis C, mixed cryoglobulinemia is mainly asymptomatic. Read More

Case Rep Dermatol 2020 Jan-Apr;12(1):25-32. Epub 2020 Feb 4.

Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan.

Although hepatitis C virus (HCV) infection is often associated with extrahepatic cutaneous manifestations such as lichen planus, it is unclear whether HCV or HCV-specific immune responses play a pathophysiological role in the development of HCV-related cutaneous diseases. We recently treated a patient who developed parapsoriasis en plaque-like lesions after ingestion of various drugs. She showed hypersensitivity to multiple drugs after interferon therapy. Read More

Cureus 2019 Nov 9;11(11):e6109. Epub 2019 Nov 9.

Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK.

Introduction Even though the liver is the main targeted organ in hepatitis C, the manifestations of the disease are not limited to hepatic involvement. Other tissue types are often involved as well. Hepatitis C has dermatological and mucocutaneous manifestations. Read More

Cureus 2019 Sep 27;11(9):e5783. Epub 2019 Sep 27.

Hospital Medicine, Aspirus Riverview Hospital, Wisconsin Rapids , USA.

We report a 64-year-old man presenting with cutaneous leukocytoclastic vasculitis, the underlying etiology of which was established as hepatitis C infection with associated cryoglobulinemia. This pathophysiologic state presented clinically as recurrent cutaneous vasculitic eruptions with the absence of any other clinical manifestations except for mild ankle swelling and weakness. This case clearly relates the need to consider hepatitis C as a potential etiologic factor in all patients with cutaneous vasculitis, and we suggest that viral hepatitis screening should be done routinely in all patients presenting with cutaneous vasculitis. Read More

J Viral Hepat 2020 03 26;27(3):333-337. Epub 2019 Nov 26.

Division of Clinical and Molecular Hepatology, University of Messina, Messina, Italy.

Apart from chronic liver disease, hepatitis C virus (HCV) may be responsible for several extra-hepatic manifestations. Its involvement in psoriasis development is still controversial. The aim of this study was to evaluate the possible effect of anti-HCV direct-acting antiviral (DAA) treatment on cutaneous psoriasis. Read More

Mol Genet Metab 2019 11 28;128(3):363-366. Epub 2018 Nov 28.

Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address:

Porphyria Cutanea Tarda (PCT) is a cutaneous porphyria that results from the hepatic inhibition of the heme biosynthetic enzyme uroporphyrinogen decarboxylase (UROD), and can occur either in the absence or presence of an inherited heterozygous UROD mutation (PCT subtypes 1 and 2, respectively). A heterozygous UROD mutation causes half-normal levels of UROD activity systemically, which is a susceptibility factor but is not sufficient alone to cause type 2 PCT. In both Types 1 and 2 PCT, the cutaneous manifestations are precipitated by additional factors that lead to generation of an inhibitor that more profoundly reduces hepatic UROD activity. Read More

Diseases 2018 May 3;6(2). Epub 2018 May 3.

Department of Clinical and Surgical Sciences, University of Trieste, 34121 Trieste, Italy.

Introduction: The clinical and therapeutic management of mixed cryoglobulinemia (MC) remains a subject of controversy. In addition, most studies have not recorded the long-term follow-up and the outcome of these cases.

Material And Methods: We enrolled 246 patients affected by MC who were consecutively admitted to our Department from January 1993 to February 2013. Read More

Cochrane Database Syst Rev 2018 May 7;5:CD011403. Epub 2018 May 7.

Department of Nephrology, Hospital Universitari de Bellvitge, Feixa Illarga s/n, L'Hospitalet de Llobregat, Barcelona, Spain, 08907.

Background: Hepatitis C virus (HCV)-associated mixed cryoglobulinaemia is the manifestation of an inflammation of small and medium-sized vessels produced by a pathogenic IgM with rheumatoid factor activity generated by an expansion of B-cells. The immune complexes formed precipitate mainly in the skin, joints, kidneys or peripheral nerve fibres. Current therapeutic approaches are aimed at elimination of HCV infection, removal of cryoglobulins and also of the B-cell clonal expansions. Read More

Wiad Lek 2018;71(1 pt 1):64-72

Studia Doktoranckie, Zakład Farmakologii, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny, Lublin.

Polyarteritis nodosa is a systemic necrotizing vasculitis which predominantly affects medium-sized arteries. It is a rare disease nowadays. Both the nomenclature and the classification of polyarteritis nodosa was amended several times in the past. Read More

Clin Rev Allergy Immunol 2018 Feb;54(1):177-184

Unité d'allergologie, Service d'immunologie et d'allergologie, Hôpitaux Universitaires de Genève HUG, Rue Micheli-du-Crest 24, CH-1211, Genève, Switzerland.

Recognition and timely adequate treatment of erythema multiforme remain a major challenge. In this review, current diagnostic guidelines, potential pitfalls, and modern/novel treatment options are summarized with the aim to help clinicians with diagnostic and therapeutic decision-making. The diagnosis of erythema multiforme, that has an acute, self-limiting course, is based on its typical clinical picture of targetoid erythematous lesions with predominant acral localization as well as histological findings. Read More

J Eur Acad Dermatol Venereol 2017 Aug 29;31(8):1260-1270. Epub 2017 Mar 29.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA.

New all-oral direct-acting antivirals (DAA) have changed the hepatitis C virus (HCV) treatment landscape. Given that dermatologists frequently encounter HCV-infected patients, knowledge of the current treatment options and their utility in treating HCV-associated dermatologic disorders is important. In addition to highlighting the new treatment options, we review four classically HCV-associated dermatologic disorders - mixed cryoglobulinaemia (MC), lichen planus (LP), porphyria cutanea tarda (PCT) and necrolytic acral erythema (NAE) - and examine the role for all-oral direct-acting antiviral (DAA) regimens in their treatment. Read More

World J Gastroenterol 2017 Feb;23(5):743-750

Youssef Alhmada, Mohamed Hassan, Department of Pathology, University of Mississippi Medical Center, Jackson, MS 39216, United States.

In addition to its contributing role in the development of chronic liver diseases, chronic hepatitis C virus (HCV) infection is associated with extrahepatic manifestations, particularly, cutaneous-based disorders including those with pruritus as a symptom. Pruritus is frequently associated with the development of chronic liver diseases such as cholestasis and chronic viral infection, and the accumulation of bile acids in patients' sera and tissues as a consequence of liver damage is considered the main cause of pruritus. In addition to their role in dietary lipid absorption, bile acids can trigger the activation of specific receptors, such as the G protein-coupled bile acid receptor (GPBA/ TGR5). Read More

Actas Dermosifiliogr 2017 05 16;108(4):365-366. Epub 2017 Feb 16.

Servicio de Dermatología, Hospital Clínic, Barcelona, España.

Clin Lab 2016 Dec;62(12):2339-2348

Background: Chronic hepatitis C (CHC) infection causes a wide range of immune mediated hepatic and extrahepatic manifestations. Cutaneous manifestations constitute a major portion of the latter group. Host immune response to the virus - particularly regulatory T lymphocytes - is important in determining the outcome of the infection and the possibility of extrahepatic manifestations. Read More

J Adv Res 2017 Mar 2;8(2):99-111. Epub 2016 Dec 2.

Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Cairo University, Egypt.

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. Read More

Rom J Morphol Embryol 2016 ;57(3):937-941

Discipline of Dermatology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Clinic of Dermatovenereology, "St. Spiridon" Emergency Hospital, Iassy, Romania;

Autoimmunity is characterized by activation of the immune system that attacks and destroys wrongly, the body's own structures. All body tissues can be affected (erythrocytes, leukocytes, platelets, blood vessels, muscle tissue, endocrine system, and other), including the skin. Autoimmune diseases have an increased frequency in women, especially in adulthood, and they are associated with hereditary factors. Read More

Indian J Gastroenterol 2016 Nov 31;35(6):405-418. Epub 2016 Oct 31.

Department of Internal Medicine, UAB University of Alabama in Birmingham, Birmingham, AL, USA.

Porphyrias are a group of metabolic disorders, which result from a specific abnormality in one of the eight enzymes of the heme biosynthetic pathway. These have been subdivided based on the predominant site of enzyme defect into hepatic and erythropoietic types and based on clinical presentation into acute neurovisceral and cutaneous blistering porphyrias. This review focuses on hepatic porphyrias, which include acute intermittent porphyria (AIP), variegate porphyria (VP), hereditary coproporphyria (HCP), aminolevulinic acid dehydratase deficiency porphyria (ADP), and porphyria cutanea tarda (PCT). Read More

Vnitr Lek Fall 2016;62(9 Suppl 2):18-22

Extrahepatic manifestations of hepatitis C virus infection (HCV) are very common. The most common of these is mixed cryoglobulinaemia. Anti-HCV antibodies and viral ribonucleic acid, HCV RNA, can be found in the cryoprecipitates, together with the rheumatoid factor. Read More

Clin Transl Gastroenterol 2016 Jul 7;7(7):e179. Epub 2016 Jul 7.

Department of Organ System Interactions and Information, Saga Medical School, Saga, Japan.

Objectives: Oral lichen planus (OLP) is one of the extrahepatic manifestations of hepatitis C virus (HCV) infection. Presently developed interferon (IFN)-free direct-acting antivirals (DAAs) used to treat HCV infection have low side effect profiles and high efficacy. However, there are no studies examining the relationship between OLP and IFN-free DAAs. Read More

Dermatol Res Pract 2015 29;2015:182609. Epub 2015 Dec 29.

Faculty of Medicine, Clinical Pathology Department, Tanta University Hospitals, El Geish Street, Tanta, Gharbia Governorate 31111, Egypt.

Background. Hepatitis C is a global major health problem with extremely variable extrahepatic manifestations. Mixed cryoglobulinaemia (MC) shows a striking association with hepatitis C virus (HCV) infection, and it is sometimes asymptomatic. Read More

Rev Esp Quimioter 2016 Feb 19;29(1):44-6. Epub 2016 Jan 19.

María Pilar Ortega García, Servicio de Farmacia, Consorcio Hospital General Universitario de Valencia Av/Tres Cruces nº2 46014 Valencia, Spain.

An Bras Dermatol 2015 Nov-Dec;90(6):828-35

Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil.

Background: Extrahepatic manifestations are seen in association with chronic infection by hepatitis B or C virus including cutaneous disorders. The frequency of these findings seems to vary among different places and reports. There is a lack of information about this issue in Brazil. Read More