Successful treatment and long-term monitoring of patient with cryoglobulinemic vasculitis, associated with chronic HCV infection. Clinical observation

Chronic HCV infection is characterized not only by severe hepatic complications, such as liver cirrhosis and hepatocellular carcinoma but also by equally serious extrahepatic manifestations. Mixed cryoglobulinemia (MC) is the most common extrahepatic complication of chronic HCV infection. Clinical manifestation of MC is cryoglobulinemic vasculitis (СV), often occurring with the development of membranoproliferative glomerulonephritis. Antiviral therapy remains an important component of the modern approach to the treatment of СV. However, the elimination of the virus is not always accompanied by clinical and immunological remission of vasculitis. This publication demonstrates a clinical case of severe СV associated with HCV infection, which debuted in 2004 with skin lesions, followed by the addition in 2009 cryoglobulinemic glomerulonephritis, and in 2014 lesions of the lungs, nervous system and joints. Corticosteroid therapy in 2009 and 2013 caused only short-term clinical remission of the disease. Hepatitis C (genotype 1) was characterized by low clinical activity with high viral load and was accompanied by an increase in the severity of liver fibrosis in dynamics. Antiviral treatment with interferon and ribavirin, used in inadequate doses of drugs due to the development of adverse events, was ineffective. Only the use of a combination of pathogenetic therapy using monoclonal antibodies to CD20 and antiviral treatment with modern direct-acting drugs (asunaprevir 200 mg/day and daclatasvir 60 mg/day) made it possible to achieve a sustained virological response and clinical remission of the disease by 2015. However, despite the elimination of cryoglobulins, which was first detected only 12 weeks after the completion of antiviral therapy, it was not possible to achieve full normalization of immunological parameters: for more than 4 years of follow-up, a high blood level of rheumatoid factor (RF) and a low concentration of the C4 component of the complement remained. The prognostic value of these disorders taking into account the possible risk of progression of the lymphoproliferation process remains unclear to date and requires further observation and analysis.

хроническая HCV-инфекция, смешанная криоглобулинемия, криоглобулинемический васкулит, chronic HCV infection, mixed cryoglobulinemia, cryoglobulinemic vasculitis

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