Gleason Tyler, Ghimire Sushil, Paladugu Susmita
Reading Health System, West Reading, Pennsylvania, USA.
BMJ Case Rep. 2017 Mar 27;2017:bcr2017219468. doi: 10.1136/bcr-2017-219468.
A 48-year-old man with a history of intravenous drug use and chronic, untreated hepatitis C presented to the emergency room with acute bilateral lower extremity swelling, erythema and maculopapular rash. Serum C4 levels were low, but dermatology felt the rash was due to venous stasis dermatitis. The patient was discharged with compression stockings, but returned to the hospital 5 days later with no improvement in his symptoms. A more extensive laboratory workup revealed hepatitis C viral load of 4 million, elevated serum cryoglobulins, and skin biopsy showing leucocytoclastic vasculitis. He was treated with oral prednisone, with complete resolution of his symptoms after 2 weeks. He was scheduled for follow-up in gastroenterology clinic for treatment of his hepatitis C for definitive cure of his mixed cryoglobulinaemia, but failed to get insurance authorisation to begin treatment with Harvoni. He presented to the hospital 4 months later with diffuse alveolar haemorrhage.
一名48岁男性，有静脉注射吸毒史且患有慢性丙型肝炎未经治疗，因急性双侧下肢肿胀、红斑和斑丘疹皮疹就诊于急诊室。血清C4水平较低，但皮肤科医生认为皮疹是由静脉淤积性皮炎引起的。患者出院时使用了弹力袜，但5天后症状无改善再次入院。更全面的实验室检查显示丙型肝炎病毒载量为400万，血清冷球蛋白升高，皮肤活检显示白细胞破碎性血管炎。他接受了口服泼尼松治疗，2周后症状完全缓解。他被安排在胃肠病学诊所进行随访，以治疗丙型肝炎，从而彻底治愈混合性冷球蛋白血症，但未能获得保险授权开始使用Harvoni治疗。4个月后，他因弥漫性肺泡出血再次入院。
