Case Report
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World J Gastrointest Pharmacol Ther. Apr 6, 2010; 1(2): 72-74
Published online Apr 6, 2010. doi: 10.4292/wjgpt.v1.i2.72
Cryoglobulinemia in elderly patients with HCV-related chronic hepatitis
Francesco Giuseppe Foschi, Anna Chiara Dall’Aglio, Arianna Lanzi, Giorgio Marano, Sara Savini, Pietro Andreone, Mauro Bernardi, Giuseppe Francesco Stefanini
Francesco Giuseppe Foschi, Anna Chiara Dall’Aglio, Arianna Lanzi, Giorgio Marano, Sara Savini, Giuseppe Francesco Stefanini, Department of Internal Medicine, Faenza Hospital, Viale Stradone 9, 48018 Faenza (RA), Italy
Pietro Andreone, Mauro Bernardi, Department of Clinical Medicine, Bologna University, Via Massarenti 9, 40138 Bologna, Italy
Author contributions: Foschi FG supervised the literature analysis and wrote the final draft of the paper; Dall’Aglio AC screened the literature and contributed to writing the first draft of the paper; Lanzi A and Savini S participated in writing the manuscript; Marano G was the referring physician of the clinical case; Bernardi M and Andreone P supervised and critically reviewed the manuscript; Stefanini GF approved the final version.
Correspondence to: Francesco Giuseppe Foschi, MD, Department of Internal Medicine, Faenza Hospital,Viale Stradone 9, 48018 Faenza (RA), Italy. fg.foschi@ausl.ra.it
Telephone: +39-546-601386 Fax: +39-546-601651
Received: January 16, 2010
Revised: February 10, 2010
Accepted: February 17, 2010
Published online: April 6, 2010
Abstract

Hepatitis C virus (HCV) infection affects about 3% of the world’s population and often leads to chronic liver disease. In some industrialized countries, HCV prevalence increases with age, but the optimal management of older patients has not been accurately defined. HCV infection can also lead to lymphoproliferative disorders, the most common being mixed cryoglobulinemia (MC), and also for this condition that frequently affects elderly patients, the optimal therapeutic strategy is still debated. We report the case of a 77-year-old Caucasian woman with HCV-related chronic hepatitis and cutaneous manifestations consisting of urticaria and pruritus related to MC resistant to antihistamines. The patient underwent a treatment with interferon and ribavirin. Such a treatment led to early biochemical and virological response associated with the resolution of cryoglobulinemia and cutaneous symptoms. After the end of treatment, HCV replication relapsed, but cryoglobulinemia and cutaneous symptoms did not recur. In the absence of definite treatment guidelines in this particular context, our experience suggests that the presence of symptoms related to HCV-infection that deeply affect patient quality of life warrants antiviral therapy even beyond the age limits that currently exclude patients from treatment.

Keywords: Cryoglobulinemia; Elderly patients; Hepatitis C virus chronic hepatitis; Antiviral treatment