Pagano Gennaro, Komici Klara, Femminella Grazia Daniela, de Lucia Claudio, Ianniciello Marta, Leosco Dario, Ferrara Nicola, Rengo Giuseppe
Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
Epilepsy Center, Department of Neurological Sciences, Federico II University of Naples, Naples, Italy.
Am J Case Rep. 2014 Feb 3;15:56-9. doi: 10.12659/AJCR.889868. eCollection 2014.
Female, 70 FINAL DIAGNOSIS: Chronic Heaptitis C Symptoms: Coma Medication: - Clinical Procedure: Plamapheresis Specialty: Neurology.
Unusual clinical course.
Hepatitis C Virus (HCV)-related chronic hepatitis can be associated with mixed cryoglobulinemia (MC). Although several MC cases have been described, the wide variety of symptoms often makes diagnosis challenging.
We describe a sudden onset of coma in a 70-year-old woman with an undiagnosed chronic hepatitis C infection related to MC. Head CT did not show any important pathology. Laboratory tests showed leucocytosis, but it was not possible to identify any pathogenic microorganism. Examination of cerebrospinal fluid did not show any pathology. There was a strongly positive test result for rheumatoid factor (409 U/l) and hypocomplementemia (C4 0.04 g/l). Laboratory assay was positive for antibodies against HCV and HCV RNA. The cryoglobulins were positive and after treatment with plasmapheresis her conditions improved.
In this case, the cryoglobulins laboratory exam was very helpful for the diagnosis. This test could be considered in the early management of elderly patients with sudden onset of coma.
女性，70岁 最终诊断：慢性丙型肝炎 症状：昏迷 用药：- 临床操作：血浆置换 专科：神经科。
不寻常的临床病程。
丙型肝炎病毒（HCV）相关的慢性肝炎可与混合性冷球蛋白血症（MC）相关。虽然已经描述了几例MC病例，但各种各样的症状往往使诊断具有挑战性。
我们描述了一名70岁女性突然昏迷，患有与MC相关的未确诊慢性丙型肝炎感染。头部CT未显示任何重要病变。实验室检查显示白细胞增多，但无法识别任何致病微生物。脑脊液检查未显示任何病变。类风湿因子检测结果呈强阳性（409 U/l）且补体低下（C4 0.04 g/l）。实验室检测抗HCV抗体和HCV RNA呈阳性。冷球蛋白呈阳性，经血浆置换治疗后病情改善。
在本病例中，冷球蛋白实验室检查对诊断非常有帮助。对于突然昏迷的老年患者的早期管理可考虑进行此项检查。
