|THROUGH THE LENS
|Year : 2018 | Volume
| Issue : 2 | Page : 135
Through the lens: Cryoglobulinemia
Shekhar Neema, D Banerjee, SK Pramanik
Department of Dermatology, Gastroenterology and Hematology, Command Hospital, Kolkata, West Bengal, India
|Date of Web Publication||19-Mar-2018|
Department of Dermatology, Gastroenterology and Hematology, Command Hospital, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Neema S, Banerjee D, Pramanik S K. Through the lens: Cryoglobulinemia. Indian Dermatol Online J 2018;9:135
A 51-year-old lady presented with episodic discoloration of lower extremities associated with severe pain of 2 years' duration. She was a nonsmoker, nondiabetic, and normotensive. On examination, she had gangrene involving the left great toe [Figure 1]. Evaluation revealed hepatitis C virus (HCV) RNA copies – 1.4 million copies/mL, genotype – 3, cryoglobulins – present, rheumatoid factor – positive and thrombocytopenia. Color Doppler involving lower limb vessels and two-dimensional echocardiography were normal. Histopathology of the skin showed fibrinoid deposits and thrombus formation in dermal capillaries without active vasculitis. Diagnosis of HCV-associated cryoglobulinemic vasculitis was made. She was treated with tablet sofosbuvir 400 mg and daclatasvir 60 mg once a day along with tablet prednisolone 40 mg once a day. She responded favorably to treatment, and review at 3 months showed resolution of skin lesions [Figure 2].
|Figure 2: Complete resolution of the gangrene with post-inflammatory pigmentation on the left great toe after 12 weeks|
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Cryoglobulinemic vasculitis develops in approximately 15% patients with HCV infection, while circulating cryoglobulins are detected in 40–60% of the patients. Viral clearance is important for the treatment of vasculitis as clinical remission is closely linked with viral clearance. Pegylated interferon α with ribavirin with or without rituximab is the standard of care for the management of cryoglobulinemic vasculitis, but 30–40% patients do not respond to this combination. With the availability of direct-acting antiviral agents, treatment of this condition has changed dramatically. In an open label multicentre study, sofosobuvir 400 mg per day and daclatasvir 60 mg per day for 12 weeks resulted in complete clinical response in 90% patients.
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| References|| |
Cooley JE, Papadimitriou JC, Kauffman CL. Hepatitis C-associated cryoglobulinemia. Cutis 1995;56:324-8.
Misiani R, Bellavita P, Fenili D, Vicari O, Marchesi D, Sironi PL, et al
. Interferon alfa-2a therapy in cryoglobulinemia associated with hepatitis C virus. N
Engl J Med 1994;330:751-6.
Welsch C, Jesudian A, Zeuzem S, Jacobson I. New direct-acting antiviral agents for the treatment of hepatitis C virus infection and perspectives. Gut 2012;61(Suppl 1):i36-46.
Saadoun D, Pol S, Ferfar Y, Alric L, Hezode C, Si Ahmed SN, et al
. Efficacy and Safety of Sofosbuvir Plus Daclatasvir for Treatment of HCV-Associated Cryoglobulinemia Vasculitis. Gastroenterology 2017;153:49-52.
[Figure 1], [Figure 2]