Extrahepatic Manifestations of Chronic Hepatitis C

August 1, 2006

Extrahepatic manifestations of chronic hepatitis C virus (HCV) infection should prompt appropriate serologic investigation.

I read with interest the recent article, "Chronic Hepatitis C: Latest Diagnosis and Treatment Guidelines," by Drs James Park, Reza Akhtar, and Douglas Dieterich (CONSULTANT, April 1, 2006, page 463). The paper is well written and timely; however, several well-established extrahepatic manifestations of chronic hepatitis C virus (HCV) infection are not included in either the clinical features synopsis or the list of risk factors that should prompt appropriate serologic investigation.

For example, among patients who present with porphyria cutanea tarda (PCT), the prevalence of chronic HCV infection is 50%.1 The converse is also true: among persons with known chronic HCV infection, the prevalence of PCT is higher than expected compared with a control group.2

Any patient who presents with laboratory-verified PCT (the chief clinical features of which are vesicles/bullae, crusted erosions, and milia on sun-exposed areas; and malar hypertrichosis [Figure]) is at risk for HCV infection. Thus, his or her care should always include comprehensive HCV diagnostic testing.

- Ted Rosen, MD
    Professor of Dermatology
    Baylor College of Medicine
    Houston

We wholeheartedly agree with your recommendation to screen for active HCV infection in all patients who present with PCT. In addition, mixed cryoglobulinemia and membranoproliferative glomerulonephritis should prompt investigation for the presence of HCV. Other syndromes, such as lymphocytic sialadenitis, lymphoproliferative disorders, leukocytoclastic vasculitis, and neuropathy, are also associated with hepatitis C, but we do not believe these relationships are as strong.

- Reza Akhtar, MD
    Department of Internal Medicine
    Mount Sinai Hospital
    New York

References:

REFERENCES:


1.

Gisbert JP, Garcia-Buey L, Pajares JM, Moreno-Otero R. Prevalence of hepatitis C virus infection in porphyria cutanea tarda: systematic review and meta-analysis.

J Hepatol

. 2003;39:620-627.

2.

El-Serag HB, Hampel H, Yeh C, Rabeneck L. Extrahepatic manifestations of hepatitis C among United States male veterans.

Hepatology

. 2002;36:1439-1445.

FOR MORE INFORMATION:

  • Bonkovsky HL, Poh-Fitzpatrick M, Pimstone N, et al. Porphyria cutanea tarda, hepatitis C, and HFE gene mutations in North America. Hepatology. 1998;27:1661-1669.

  • Fargion S, Piperno A, Cappellini MD, et al. Hepatitis C virus and porphyria cutanea tarda: evidence of a strong association. Hepatology. 1992;16:1322-1326.

  • Gisbert JP, Garcia-Buey L, Pajares JM, Moreno-Otero R. Prevalence of hepatitis C virus infection in porphyria cutanea tarda: systematic review and meta-analysis. J Hepatol. 2003;39:620-627.

  • Palekar NA, Harrison SA. Extrahepatic manifestations of hepatitis C. South Med J. 2005;98:1019-1023.

  • Sams H, Kiripolsky MG, Bhat L, Stricklin GP. Porphyria cutanea tarda, hepatitis C, alcoholism, and hemochromatosis: a case report and review of the literature. Cutis. 2004;73:188-190.

  • Thevenot T, Bachmeyer C, Hammi R, et al. Occurrence of porphyria cutanea tarda during peginterferon/ ribavirin therapy for chronic viral hepatitis C. J Hepatol. 2005;42:607-608.