Eradication of hepatitits C virus in patient with cryoglobulinemic vasculitis and mutations D168E, L31V

Abstract

The case of chronic hepatitis C 1b genotype with grade 3 fibrosis according to Metavir, complicated by the development of mixed type III cryoglobulinemia, cryoglobulinemic vasculitis with damage to the skin vessels of the skin (hemorrhagic vasculitis), and the liver (alternatively proliferative vasculitis) is demonstrated. The introduction of daclatasvir + asunaprevir was virologically unsuccessful: mutations D168E and L31V were detected against the background of a virological breakthrough. A repeated course of antiviral therapy with the combination of Grazoprevir + Elbasvir in combination with sofosbuvir led to a stable virologic response, partial immunological and clinical remission.

Keywords

• chronic hepatitis c, cryoglobulinemia, cryoglobulinemic vasculitis, elbasvir, grazoprevir, sofosbuvir, daclatasvir, asunaprevir, mutations, resistance