HCV related severe cryoglobulinemic vasculitis treated with plasma exchange and rituximab: case report and literature review

  • Snezana Arandjelovic Clinical Centre of Serbia, Belgrade, Serbia
  • Branka Bonaci-Nikolic Clinical Centre of Serbia, Belgrade, Serbia
  • Aleksandra Peric-Popadic Clinical Centre of Serbia, Belgrade, Serbia
  • Vesna Tomic-Spiric Clinical Centre of Serbia, Belgrade, Serbia
  • Jasna Bolpacic Clinical Centre of Serbia, Belgrade, Serbia
  • Sanvila Raskovic Clinical Centre of Serbia, Belgrade, Serbia
  • Sladjana Andrejevic Clinical Centre of Serbia, Belgrade, Serbia
Keywords: hepatitis C virus, hepatitis C virus (HCV), HCV, cryoglobulinemic vasculitis, life-threatening cryoglobulinemia, rituximab

Abstract

Mixed cryoglobulinemia is the most prevalent extrahepatic manifestation of chronic HCV infection. It is usually a benign lymphoproliferative disorder which presents as vasculitis affecting different organs. Although life-threatening cryoglobulinemic vasculitis (CryoVas) is rare, it is sometimes the first and possibly lethal complication. Its treatment depends on the severity of vasculitis and can be challenging. High dose of corticosteroids, immunosuppressive agents and plasma exchange represent the first-line treatment, which should be followed by antiviral therapy. Rituximab is an effective and safe treatment option. However, the data about its use in life-threatening conditions are scarce. We report the case of a patient with severe, relapsing and life-threatening HCV-related CryoVas  resistant to standard therapy who had had an initial beneficial response to rituximab added to plasma exchange that was later compromised by the development of sepsis. We also review the literature and discuss manifestations and therapy of life-threatening Cryovas with focus on rituximab use.

Author Biographies

Snezana Arandjelovic, Clinical Centre of Serbia, Belgrade, Serbia

Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Asistant in Internal Medicine,

Branka Bonaci-Nikolic, Clinical Centre of Serbia, Belgrade, Serbia

Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Profesor in Internal Medicine,

 

Aleksandra Peric-Popadic, Clinical Centre of Serbia, Belgrade, Serbia

Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Profesor in Internal Medicine

 

 

Vesna Tomic-Spiric, Clinical Centre of Serbia, Belgrade, Serbia

Faculty of Medicine, University of Belgrade, Serbia

Profesor in Internal Medicine

 

 

Jasna Bolpacic, Clinical Centre of Serbia, Belgrade, Serbia

Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Assistent Profesor in Internal Medicine

Sanvila Raskovic, Clinical Centre of Serbia, Belgrade, Serbia

Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Profesor in Internal Medicine

 

Sladjana Andrejevic, Clinical Centre of Serbia, Belgrade, Serbia

Faculty of Medicine,University of Belgrade, Belgrade, Serbia

Asistant in Internal medicine

 

Published
2017-06-01
How to Cite
1.
Arandjelovic S, Bonaci-Nikolic B, Peric-Popadic A, Tomic-Spiric V, Bolpacic J, Raskovic S, Andrejevic S (2017) HCV related severe cryoglobulinemic vasculitis treated with plasma exchange and rituximab: case report and literature review. J Infect Dev Ctries 11:431-436. doi: 10.3855/jidc.8290
Section
Case Reports