Systemic manifestations of chronic viral hepatitis

Aim: HBV and HCV infections are often associated with extrahepatic manifestations, e.g. arthritis, cryoglobulinemia, glomerulonephritis, polyarteritis nodosa, aplastic anaemia, urticaria etc. A short review is given on these and other immunological alterations and on the author's experiences in this field.

Patients and Methods One hundred patients (pts) with chronic hepatitis C, 44 pts with non-Hodgkin lymphoma (NHL) and 50 pts with porphyria cutanea tarda (PCT) have been studied. Serological tests, cryoglobulins, circulating immune complexes (CIC), rheumatoid factor (RF), antinuclear (ANA), anti-smooth muscle (SMA), anti-thyroid, anti-liver-kidney (LKM) and anti-SSA autoantibodies have been detected by means of standard techniques.

Results: Concerning HBV infection, in a case of „cryptogenic cirrhosis associated with nephrotic syndrome“ an HBsAg-induced immune complex membranous glomerulonephritis was proven. In chronic hepatitis C, RF was detected in 42%, mixed cryoglobulinemia in 34%, CIC in 28%, thyroid autoantibodies in 22%, anti-SSA in 17%, ANA in 15%, SMA in 15%, and anti-LKM in 10%, respectively. Prevalence of NHL was 5% and that of PCT was 4% in chronic hepatitis C pts, while HCV infection was detected in 23.8% of NHL and 44% of PCT cases. Various HCV-related dermatological diseases have been shown, e.g. leukocytoclastic vasculitis, lichen ruber, prurigo, cutaneous lymphoma, erythema multiforme and cutis marmorata.

Conclusion The presence of extrahepatic manifestations and/or immunserological alterations listed in the review, may suggest chronic HBV or HCV infections, and viral markers should be tested to clarify the etiological associations. Then, according to the evidence, even antiviral therapy should be considered, although high titer of autoantibodies may indicate a risk for treatment with interferon.

The study was supported by a grant from National Research Fund (OTKA T17 49186).