CHRONIC HEPATITIS C WITH EXTRAHEPATIC MANIFESTATIONS

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Alaa on Jan 20, 2011 Says :

THANKS FOR GREAT HELP FOR PREPARING OUR CME & GIVING MORE KNOWLEGDE, WISHING FOR ALL TEAM PREPARING THESE SLIDES THE BEST WISHES & SUCCESS

hasarika on Sep 11, 2009 Says :

want to know about hepatitis c

hasarika on Sep 11, 2009 Says :

want to know about extrahepatic manifestations of hepatitis

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Slide 1 :

CHRONIC HEPATITIS C WITH EXTRAHEPATIC MANIFESTATIONS CASE REPORT LAURA POANTA, ADRIANA ALBU UMF Iuliu Hatieganu Cluj-Napoca Romania

Slide 2 :

INTRODUCTION Chronic hepatitis C it is often asymptomatic and it is mostly discovered accidentally. Chronic hepatitis C may be diagnosed with extrahepatic manifestations (thyroiditis, porphyria cutanea tarda, cryoglobulinemia) In patients with hepatitis B and C psoriasis may be induced or exacerbated by systemic interferon-alpha therapy.

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CASE REPORT M.F., 35-years-old, male. Symptoms: abdominal discomfort, exercise-induced pain in the right upper quadrant of the abdomen, fatigue. Family history: both parents with hypertension. Personal history: porphyria cutanea tarda. No alcohol drinking, no smoking.

Slide 4 :

History: Two months before the examination: pain in the right-upper abdominal quadrant with exercise, fatigue. Ambulatory lab tests: elevated AST and ALT hospital admission Physical exam: Skin: hyperpigmentation with areas of hypo pigmentation, scars at the level of the upper extremities, ulcerative lesions covered by hemorrhagic crusts on the back of the hands Abdomen: enlarged liver, increased density, rounded anterior margin, slightly sensitive to palpation. Clinical interpretation: HEPATOMEGALIC SYNDROME PORPHYRIA CUTANEA TARDA

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LABORATORY FINDINGS ESR 10-20 Hb 13,5 g % Ht 40% L 5600/mm3 Platelets 278000/mm3 Normal immunoglobulins Negative ANA, AMA, LKM1A Viral markers: negative HBs antigen positive HCV antibodies Fasting plasma glucose 90mg % Cholesterol 160 mg % Triglycerides 180 mg % BUN 40mg% Creatinine 1mg%, AST 124U/L, ALT 180U/L AP 101 U/l GGT 20 U/l Bilirubin 0,8 mg % CHE 7800 mg % Serum proteins electrophoresis within normal range

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ECG: Sinus rhythm, sinus bradycardia. Abdominal ultrasound: Hepatomegaly, left lobe 113 mm, right lobe 150 mm, inhomogeneous structure, without focal nodular formations. Distended gallbladder with thickened walls, no gallstones. Portal vein: 12 mm, preserved respiratory compliance, superior mesenteric vein: 9 mm, spleen vein: 8 mm, round ligament without signs of canalization. No ascites. Normal pancreas, kidneys, urinary bladder, prostate. Upper gastro-intestinal endoscopy: Normal esophagus. Chronic erosions in the pyloric antrum – biopsy. Dermatological examination: Porphyria cutanea tarda, sporadic type, by HCV. LABORATORY FINDINGS

Slide 7 :

Positive diagnosis ACTIVE CHRONIC HEPATITIS C PORPHYRIA CUTANEA TARDA HP-POSITIVE ANTRAL GASTRITIS Differential diagnoses: chronic toxic hepatitis by chronic ethanol intake chronic toxic hepatitis by chronic intake of hepatotoxic drugs autoimmune hepatitis primary biliary cirrhosis Wilson’s disease hemochromatosis

Slide 8 :

Treatment: Pegylated interferon and Ribavirin (after liver puncture biopsy) Evolution: no response to therapy (no biochemical, serological or histological changes). During follow-up: a new erythematous skin rash on the scalp, elbows and knees, covered by white squamous crusts. Dermatological examination: psoriasis vulgaris.

Slide 9 :

DISCUSSIONS Hepatitis C virus infection a major factor triggering manifest symptoms of porphyria cutanea tarda. screen all patients with porphyria cutanea tarda for hepatitis C virus infection!

Slide 10 :

DISCUSSIONS In previous reported cases psoriasis was induced or exacerbated by systemic interferon-alpha therapy The psoriatic lesions in our case disappeared in 4 weeks after the discontinuation of the therapy

Slide 11 :

Case report summary porphyria cutanea tarda screening (unknown exposure) viral hepatitis C interferon alpha therapy psoriasis

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CHRONIC HEPATITIS C WITH EXTRAHEPATIC MANIFESTATIONS
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