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Hepatic and Mesenteric Vasculitis as Presenting Manifestation of Mixed Cryoglobulinemia Related to Chronic Hepatitis C Virus Infection in a Female Patient

Calle Toro, Juan S. MD; Davalos, Diana M. MD, MSc; Charry, Jose D. MD; Arrunategi, Ana M. MD; Tobon, Gabriel MD, PhD

JCR: Journal of Clinical Rheumatology: June 2016 - Volume 22 - Issue 4 - p 212–214
doi: 10.1097/RHU.0000000000000399
Medical Student Report

Abstract: Approximately 80% of patients with hepatitis C virus infection develop chronic liver disease as cirrhosis, and 40% develop autoimmune complications as mixed cryoglobulinemia (MC). Gastrointestinal involvement in MC is rare, and even more so is hepatic involvement. We report a case of an 87-year-old woman with a 10-year history of blood transfusion–acquired hepatitis C virus infection, without treatment. She consulted the emergency department for diffuse abdominal pain, associated with vomiting. After 2 weeks of hospitalization in the intensive care unit, a diagnosis of MC was made; cirrhosis and secondary mesenteric and hepatic vasculitis were confirmed by a diagnostic laparoscopy. Unfortunately the condition of the patient worsened with sepsis and resulted in death in the fourth week from admission. This case highlights the importance of having in mind gastrointestinal tract vasculitis as a medical cause of abdominal pain in patients with chronic hepatitis C virus infection and using data laboratory tests, images, and histopathologic studies to aid with the diagnosis.

From the *Universidad ICESI, Fundación Valle del Lili, Cali; †Public Health Department, Universidad ICESI, Cali; ‡Universidad Surcolombiana, Neiva; and §Pathology and ∥Rheumathology unit, Fundacion Valle del Lili, Cali, Colombia.

J.S.C.T. is a medical student at Universidad ICESI, Fundación Valle del Lili, Cali, Colombia.

The authors declare no conflict of interest.

Correspondence: Juan S. Calle Toro, MD, Universidad ICESI, Calle 18 No. 122-135, Cali, Colombia. E-mail: ctjuans@gmail.com.

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