Beuthien Wilke, Mellinghoff Hans-Ullrich, Kempis Johannes von
Division of Rheumatology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland,
Clin Rheumatol. 2005 Sep;24(5):507-15. doi: 10.1007/s10067-005-1093-x. Epub 2005 Jun 30.
Chronic infection with hepatitis C virus (HCV) may be complicated by the development of systemic vasculitis. Vasculitis is either caused by mixed cryoglobulinemia or a non-cryoglobulinemic vasculitis resembling polyarteritis nodosa (PAN). Antiviral treatment with interferon-alpha (IFN) and subsequent clearing of HCV mostly leads to improvement of vasculitic symptoms, but vasculitis may also be exacerbated and even cases of new onset of vasculitis may occur. Exacerbations of both cryoglobulinemic and PAN-type vasculitis in chronic HCV infection have been described under treatment with IFN. The most common symptom is vasculitic neuropathy. However, peripheral neuropathy in a HCV-infected patient treated with IFN may also be caused by direct neurotoxic or antiangiogenic effects of IFN itself, often requiring a nerve biopsy to establish the exact diagnosis. The clinical course of vasculitic complications of IFN treatment is variable and ranges from regression of symptoms despite continuation of IFN treatment to fatal exacerbations despite termination of IFN treatment and additional immunosuppressive therapy. In most cases of IFN-induced vasculitis, immunosuppressive therapy with corticosteroids has been employed, leading to improvement of symptoms. We report the case of a patient with chronic HCV infection who first developed cryoglobulinemic vasculitis after initiation of therapy with the polyethylene glycol (PEG)-conjugated form of IFN (PEG-IFN) and discuss it in the context of the relevant literature. First onset of cryoglobulinemic vasculitis after initiation of IFN therapy has not been described so far.
丙型肝炎病毒（HCV）慢性感染可能并发系统性血管炎。血管炎由混合性冷球蛋白血症或类似结节性多动脉炎（PAN）的非冷球蛋白血症性血管炎引起。用α干扰素（IFN）进行抗病毒治疗并随后清除HCV大多会使血管炎症状得到改善，但血管炎也可能会加重，甚至可能出现新发血管炎病例。在IFN治疗期间，已描述了慢性HCV感染中冷球蛋白血症性血管炎和PAN型血管炎的加重情况。最常见的症状是血管炎性神经病变。然而，接受IFN治疗的HCV感染患者的周围神经病变也可能由IFN本身的直接神经毒性或抗血管生成作用引起，通常需要进行神经活检以明确诊断。IFN治疗的血管炎并发症的临床病程各不相同，从尽管继续使用IFN治疗但症状仍消退到尽管停用IFN治疗并进行额外的免疫抑制治疗仍出现致命性加重。在大多数IFN诱导的血管炎病例中，已采用皮质类固醇进行免疫抑制治疗，症状得到改善。我们报告了一例慢性HCV感染患者，该患者在开始使用聚乙二醇（PEG）共轭形式的IFN（PEG-IFN）治疗后首次出现冷球蛋白血症性血管炎，并结合相关文献进行讨论。IFN治疗开始后首次出现冷球蛋白血症性血管炎的情况迄今尚未见报道。
