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THROUGH THE LENS
Year : 2018  |  Volume : 9  |  Issue : 2  |  Page : 135  

Through the lens: Cryoglobulinemia


Department of Dermatology, Gastroenterology and Hematology, Command Hospital, Kolkata, West Bengal, India

Date of Web Publication19-Mar-2018

Correspondence Address:
Shekhar Neema
Department of Dermatology, Gastroenterology and Hematology, Command Hospital, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_176_17

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How to cite this article:
Neema S, Banerjee D, Pramanik S K. Through the lens: Cryoglobulinemia. Indian Dermatol Online J 2018;9:135

How to cite this URL:
Neema S, Banerjee D, Pramanik S K. Through the lens: Cryoglobulinemia. Indian Dermatol Online J [serial online] 2018 [cited 2020 Feb 29];9:135. Available from: http://www.idoj.in/text.asp?2018/9/2/135/227790



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 1: Gangrene involving the left great toe

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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.[1] 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.[2] With the availability of direct-acting antiviral agents, treatment of this condition has changed dramatically.[3] 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.[4]

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Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Cooley JE, Papadimitriou JC, Kauffman CL. Hepatitis C-associated cryoglobulinemia. Cutis 1995;56:324-8.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
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.  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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