“Explosive” worsening of chronic hepatitis C-associated cryoglobulinemia vasculitis, as unmasking of lymphoma a case report.

Abstract

Introduction and Objectives: Hepatitis C virus (HCV)- related lymphoproliferative disease from cryoglobulinemia to B-cell non-Hodgkin lymphoma (B-NHL) through cryoglobulinemic vasculitis (CryoVas). The CryoVas is difficult to diagnose; once diagnosed, we must rule out the HCV infection. We presented a patient with HCV and CryoVas, which presented a sudden “explosive” worsening, warning about the development of a B-NHL. Materials and Patients: 55-year-old male with HCV and CryoVas; what was the trigger for the diagnosis of HCV twenty years before? He received pegylated interferon and ribavirin without response. The virological, biochemical, and immunological characteristics are shown in Table 1. The flare of CryoVas appeared twice a year at most, limited to purpuric lesions on the legs, below the knees, arthralgia, and fatigue; was often triggered by infections, self-limiting throughout 2 to 3 weeks. The last flare started as usual but getting worse rapidly, spreading to the thighs, abdomen, chest, and upper extremities, plus fever, nocturnal diaphoresis, severe wasting, and inguinal, axillary lymph nodes. Lymph node biopsy shows diffuse large B-cell lymphoma (DLBCL) Results: He received chemotherapy (CT), previously was re-treated with sofosbuvir/velpatasvir for 12 weeks. Five months after first-line treatment for DLBCL he presented an early relapse and received a second line of CT; at 3-year follow-up is in remission with no relapse of CryoVas, waiting for a bone marrow transplant. Conclusions: Clinicians treating hepatitis C should be aware of the need to carry out immunological parameters at the basal evaluation, such as cryoglobulins, rheumatoid factor, C4 fraction, and even a flow cytometry in specific patients to the detection of leukemias and/or related lymphomas.