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Complications of Chronic Hepatitis C

Problems Outside the Liver Associated with Hepatitis C

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Updated May 29, 2009

Chronic hepatitis C affects the liver, but sometimes it's also associated with many diseases outside of the liver (extrahepatic diseases). The association between these diseases and chronic hepatitis C infection is strong enough that it's a good idea to look for one if you have the other. Many of these extrahepatic manifestations of hepatitis C infection can be grouped into four types: blood disorders, autoimmune disorders, skin conditions and kidney disease. Here's a list and brief explanation of some of these complications:

Blood Disorders

  • Essential mixed cryoglobulinemia. This is a disorder caused by abnormal proteins in the blood called cryoglobulins (which in this condition are made up of various antibody types) that leads to joint pains, arthritis, enlarged spleen, inflammation of blood vessels in the skin, and nerve and kidney disease.
  • Monoclonal gammopathy (an abnormal level of an immunoglobulin protein in the blood). This seems to be most associated with the hepatitis C virus (HCV) genotype 2a/c.
  • Lymphoma. This is a type of cancer affecting a certain kind of cell in the immune system known as a lymphocyte. Though rare, studies have shown an association between chronic hepatitis C infection and B-cell non-Hodgkins lymphoma. This seems to be most common in patients with immunocytoma (a low-grade malignancy) previously associated with cryoglobulinemia.

Autoimmune Disorders

  • Thyroid disease. Among other disorders, patients with chronic hepatitis C can have problems with hypothyroidism. This seems to affect women more than men.
  • Sialadenitis. This is inflammation of a salivary gland that, when it's associated with hepatitis C, is very similar to Sjögren's syndrome (pronounced SHOW-grins).
  • Autoimmune thrombocytopenic purpura. Called ITP (or ATP) for short, this disorder causes bruising and bleeding under the skin brought on by a decrease in the number of platelets (destroyed by the immune system).

Skin Conditions

  • Porphyria cutanea tarda (PCT). This skin disorder is characterized by sun sensitivity, fragile skin, blistering and easy bruising. Though it's not clear how HCV is involved, there is a strong association between hepatitis C and the sporadic form of PCT.
  • Leukocytoclastic vasculitis. This is an inflammation of small blood vessels, sometimes in the skin, which often leads to small, dark, round lesions. This condition may also be present with essential mixed cryoglobulinemia.
  • Lichen planus. This skin condition is characterized by flat-topped, purple-colored itchy bumps on the skin or mucous membranes that can coalesce to form larger plaques. This condition is also associated with many liver diseases, particularly advanced liver disease.
  • Necrolytic acral erythema. This condition, first described in Egypt, is rare in the United States. It's an itchy, psoriasis-like skin disease that is completely associated with hepatitis C.

Kidney Disease

  • Membranoproliferative glomerulonephritis. This is a type of glomerulonephritis where the damage is caused by the immune system. This is usually associated with essential mixed cryoglobulinemia.
  • Membranous nephropathy

Other Associated Complications

In addition to the above diseases, other problems are associated with chronic hepatitis C infection. These include diabetes mellitus, various eye disorders and osteosclerosis (a type of bone thickening disorder usually seen in patients with a history of IV drug abuse or in patients with hepatitis C after blood transfusions).

Sources:

Chopra, S. Extrahepatic Manifestations of Hepatitis C Virus Infection. UpToDate. Accessed: March 20, 2009.

Dienstag, JL. "Acute Viral Hepatitis and Chronic Hepatitis." Harrison's Principles of Internal Medicine 17e. 2008.

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