A lethal course of chronic hepatitis C, glomerulonephritis, and pulmonary vasculitis unresponsive to interferon treatment.

Abstract

Several extrahepatic syndromes have been associated with chronic hepatitis C virus infection. In our patient (a 57-yr-old woman without risk factors for hepatitis), chronic active hepatitis C was diagnosed serologically and histologically. Three months later, membranoproliferative glomerulonephritis with compromised renal function and peripheral edema, cryoglobulinemia, and a vasculitis of the finger tips developed. During interferon treatment for 3 months, neither the clinical condition nor serological parameters improved significantly. Progressive dyspnea was due to bilobar pulmonary infiltration. Despite antibiotic, virostatic, and corticosteroid therapy, the patient died from respiratory failure. Autopsy revealed diffuse pulmonary vasculitis. Thus, this is the first description of chronic hepatitis C virus infection, glomerulonephritis, and cryoglobulinemia complicated by immunologically mediated pulmonary vasculitis. Because interferon therapy may be ineffective, immunosuppressive therapy should be considered.