Manna R, Todaro L, Latteri M, Gambassi G, Massi G, Grillo M R, Romito A, Caputo S, Gasbarrini G B
Department of Internal Medicine, Catholic University of Sacred Heart, Rome, Italy.
Br J Rheumatol. 1997 Jan;36(1):124-5. doi: 10.1093/rheumatology/36.1.124.
The actiopathogenesis of leucocytoclastic vasculitis is still unknown, but recently hepatitis C virus (HCV) has been suggested as trigger of autoimmunity. We report a case of a 26-yr-old patient with purpura due to leucocytoclastic vasculitis associated with hepatitis C virus infection. Laboratory findings showed AST, ALT, gamma GT within normal limits, positive antibodies to HCV (IIF and Riba II) and polymerase chain reaction for HCV RNA. Anti-nuclear antibodies, IgG and IgM anti-cardiolipin antibodies, anti-platelet antibodies and anti-neutrophil cytoplasmic antibodies with perinuclear pattern were also present. A skin biopsy specimen of a purpuric lesion showed leucocytoclastic vasculitis with small vessel thrombosis and perivascular deposition of IgM and fibrinogen on immunofluorescence study. This case shows a role of HCV in leucocytoclastic vasculitis; it is possible that this HCV can induce autoimmunity independently of cryoglobulins and liver involvement.
白细胞破碎性血管炎的发病机制尚不清楚，但最近有研究表明丙型肝炎病毒（HCV）可能是自身免疫的触发因素。我们报告一例26岁因白细胞破碎性血管炎伴丙型肝炎病毒感染而出现紫癜的患者。实验室检查结果显示，谷草转氨酶、谷丙转氨酶、γ-谷氨酰转肽酶均在正常范围内，抗HCV抗体（间接免疫荧光法和重组免疫印迹法II）及HCV RNA聚合酶链反应呈阳性。同时还存在抗核抗体、IgG和IgM抗心磷脂抗体、抗血小板抗体以及核周型抗中性粒细胞胞浆抗体。紫癜皮损的皮肤活检标本显示白细胞破碎性血管炎，伴有小血管血栓形成，免疫荧光检查显示IgM和纤维蛋白原在血管周围沉积。该病例表明HCV在白细胞破碎性血管炎中发挥作用；这种HCV有可能独立于冷球蛋白和肝脏受累而诱导自身免疫。
