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    ExtraHepatic Manifestations of HCV-symptoms and signs of HCV that are manifested in organs other than the liver,
    Melissa Palmer, MD posted:
    @font-face { font-family: "Times New Roman"; }@font-face { font-family: "GillSans BoldItalic"; }p.MsoNormal, li.MsoNormal, div.MsoNormal { margin: 0in 0in 0.0001pt; font-size: 12pt; font-family: Times; }table.MsoNormalTable { font-size: 10pt; font-family: "Times New Roman"; }p.Text, li.Text, div.Text { margin: 0in 0in 0.0001pt; text-align: justify; line-height: 12pt; font-size: 10pt; font-family: Times; }p.DHead, li.DHead, div.DHead { margin: 8.5pt 0in 4pt; line-height: 12pt; page-break-after: avoid; font-size: 10pt; font-family: "GillSans BoldItalic"; }div.Section1 { page: Section1; }People with chronic hepatitis C often have symptoms and signs of infection that are manifested in organs other than the liver, known as extrahepatic manifestations. This is partly due to the fact that other parts of the body are often caught in the crossfire when the immune system fights against an HCV infection. These extrahepatic symptoms are known as immune-complex mediated diseases. The following is a brief discussion of some of the extrahepatic manifestations of chronic hepatitis C.

    Skin Diseases
    Vasculitis—inflammation of blood vessels—may present (show up during a doctor's initial examination of a patient) as a raised, purplish skin discoloration, known as purpura, which is most commonly located on the legs. This discoloration is due to the leakage of blood under the skin.

    Porphyria cutanea tarda (PCT) is a skin abnormality that may present as easy bruising of the skin, in addition to blisters that are sensitive to the sun and bleed easily. Areas of increased or decreased skin pigmentation and increased hair growth, known as hirsuitism, may also be associated with PCT. In addition to HCV, alcohol, excessive iron, and estrogens are believed to precipitate the manifestations of PCT in predisposed people.

    Lichen planus is a raised, itchy skin rash that often occurs in the mouth, hair, and nails.
    Several other skin changes have been noted to occur in association with chronic hepatitis C, but further study needs to be conducted to clarify their significance.

    Hematological (Blood-Related) Diseases
    Cryoglobulinemia (excess proteins in the blood) presents with purpura, joint aches (known as arthralgias), and weakness. Cryoglobulinemia may also affect the kidneys, brain, and nerves. Although cryoglobulinemia has been found in approximately 40 percent of all individuals with chronic hepatitis C, only about half of these people experience symptoms related to cryoglobulinemia.

    Lymphoma is a malignant tumor of the lymphoid tissue (cells related to the im?mune system) that has infrequently been found in people with chronic hepatitis C.

    Idiopathic thrombocytopenic purpura (ITP) is a disease characterized by an abnormally low platelet count of unclear origin and is generally manifested in the form of a rash. It is believed to be caused by an immune attack on platelets. A consequence of ITP may be a bleeding disorder, as the function of platelets is to facilitate the clotting of blood.

    Endocrine Disorders
    Thyroid disorders, both hypothyroid (an overly slow thyroid) and hyperthyroid (an overly fast thyroid) have been noted to occur in approximately 5 percent of the individuals with chronic hepatitis C. These disorders often worsen once therapy with interferon (see Chapter 13) has been initiated.

    Diabetes—elevated blood sugar (glucose) levels—has been found to be present in many people with chronic hepatitis C in some studies, but further study is needed to confirm this association.

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