Cryoglobulinemic vasculitis with multiple digital necrosis in viral hepatitis.

Cryoglobulinemic vasculitis (CV) associated with viral hepatitis C (VHC) is halfway between classical autoimmune disease and neoplasia. The extrahepatic manifestations of viral hepatitis C are various, their majority being due to mixed cryoglobulinemia. Patients diagnosed with viral hepatitis C often have mixed serum cryoglobulins, but only 5-10% of them will develop clinically manifest cryoglobulinemic vasculitis. CV symptomatology is most frequently obvious at skin level. The clinical manifestation characteristic of CV is purpura. Digital necrosis as the last stage of trophic disorders associated with CV has been rarely described in the literature. All CV types may be complicated by renal impairment. A 10-30% proportion of patients with VHC infection will develop glomerulonephritis. The treatment of cryobulinemic vasculitis associated with viral hepatitis C is focused on the reduction of viral load, the control of vasculitis symptoms using corticoids, plasmapheresis, immunosuppressive drugs, and the reduction of the amount of cryoglobulins acting on B lymphocytes. We present a rare case of cryoglobulinemic vasculitis with multiple digital necrosis associated with viral hepatitis C.