Diseases and Conditions Associated with Hepatitis C

October 29, 2006

by V. J. , RN, BSN, MA

Article Date: 9/1/2004

Hepatitis C is associated with a variety of diseases and conditions. This

does not mean that HCV causes these condition, or that they cause HCV - it

means that these conditions are sometimes found more frequently in patients

who have hepatitis C.

The first section of this article describes the various conditions and

illnesses associated with hepatitis C. The second section (page 2) lists

relevant studies, organized by disease state.

Autoimmune and Inflammatory Disorders

Behcet's Disease

Behcet's disease is a rare, chronic inflammatory disorder. Symptoms of

Behcet's disease include recurrent ulcers in the mouth (resembling canker

sores) and on the genitals, and eye inflammation.

The disorder may also cause various types of skin lesions, arthritis, bowel

inflammation, meningitis (inflammation of the membranes of the brain and

spinal cord), and cranial nerve palsies.

Behcet's is a multi-system disease; it may involve all organs and affect the

central nervous system, causing memory loss and impaired speech, balance,

and movement.

Cerebral Vasculitis

Cerebral vasculitis is a disorder characterized by inflammation and necrosis

(tissue death) of one or more arteries.

It commonly occurs in the head, especially the temporal arteries that branch

off of the carotid artery of the neck. The cause is unknown but is assumed

to be related to an immune response.

Cutaneous Vasculitis

Cutaneous vasculitis is a type of inflammation that can affect any of the

vessels in the skin including capillaries, venules, arterioles and

lymphatics.

Cutaneous vasculitis can be due to any of several different causes and can

have a wide variety of clinical presentations. It can be acute, subacute or

chronic, and can affect both large and small blood vessels.

When associated with tissue death, it is described as " necrotizing. "

Polyarteritis Nodosa

Polyarteritis nodosa is a disease of unknown cause that affects arteries,

the blood vessels which carry oxygenated blood to organs and tissues.

It occurs when certain immune cells attack the affected arteries, and

damages the tissues supplied by the affected arteries because they don't

receive enough oxygen and nourishment without a proper blood supply.

In this disease, symptoms result from damage to affected organs, often the

skin, heart, kidneys, and nervous system. Generalized symptoms include

fever, fatigue, weakness, loss of appetite, and weight loss.

Muscle aches (myalgia) and joint aches arthralgia) are common. The skin may

show rashes, swelling, ulcers, and lumps (nodular lesions).

Nerve involvement may cause sensory changes with numbness, pain, burning,

and weakness. Central nervous system involvement may cause strokes or

seizures. Kidney involvement can produce varying degrees of renal failure.

Involvement of the arteries of the heart may cause a heart attack (acute

myocardial infarction), heart failure, and inflammation of the sack around

the heart (pericarditis).

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic (long-term) inflammatory disease that

primarily affects the joints and surrounding tissues, but can also affect

other organ systems.

Rheumatoid arthritis involves an attack on the body by its own immune cells

(auto-immune disease). Different cases may have different causes.

Infectious, genetic, and hormonal factors may play a role.

The disease can occur at any age, but it begins most often between the ages

of 25 and 55. The disease is more common in older people. Women are affected

more often than men.

Approximately 1-2% of the total population is affected. The course and the

severity of the illness can vary considerably.

The onset of the disease is usually gradual, with fatigue, morning stiffness

(lasting more than one hour), diffuse muscle aches, loss of appetite, and

weakness.

Eventually, joint pain appears, with warmth, swelling, tenderness, and

stiffness of the joint after inactivity. RA usually affects joints on both

sides of the body equally - wrists, fingers, knees, feet, and ankles are the

most commonly affected.

Sjogren's Syndrome / Sicca Syndrome

Sjogren's syndrome is an autoimmune disorder in which immune cells attack

and destroy the glands that produce tears and saliva.

Sjogren's syndrome is also associated with rheumatic disorders such as

rheumatoid arthritis. The hallmark symptoms of the disorder are dry mouth

and dry eyes.

In addition, Sjogren's syndrome may cause skin, nose, and vaginal dryness,

and may affect other organs of the body including the kidneys, blood

vessels, lungs, liver, pancreas, and brain.

Sjogren's syndrome can damage vital organs of the body with symptoms that

may remain stable, worsen, or go into remission.

Some people may experience only the mild symptoms of dry eyes and mouth,

while others go through cycles of good health followed by severe disease.

Debilitating fatigue and joint pain can seriously impair quality of life.

Many patients are able to treat problems symptomatically. Others are forced

to cope with blurred vision, constant eye discomfort, recurrent mouth

infections, swollen parotid glands, hoarseness, and difficulty in swallowing

and eating.

The term " sicca " refers to the dryness of the eyes and mouth.

Systemic Lupus Erythematosus

In systemic lupus erythematosus (SLE) and other autoimmune diseases, the

body's defenses against infection are turned against the body and rogue

immune cells attack tissues.

Antibodies may be produced that can react against the body's blood cells,

organs, and tissues. These lead immune cells to attack the affected systems,

producing chronic disease.

The mechanism or cause of autoimmune diseases is not fully known, but many

researchers suspect it occurs following infection with an organism that

looks similar to particular proteins in the body, which are later mistaken

for the organism and wrongly targeted for attack.

The course of the disease may vary from a mild episodic illness to a severe

fatal disease. Symptoms also vary widely in a particular individual over

time and are characterized by periods of remission and exacerbation.

At its onset, only one organ system may be involved. Additional organs may

become involved later.

Blood and Circulatory Disorders

Agranulocytosis

Agranulocytosis is a condition in which there is an insufficient number of

white blood cells called neutrophils or granulocytes.

This can be caused by a failure of the bone marrow to make sufficient

neutrophils or when white blood cells are destroyed faster than they can be

produced. Affected people are susceptible to infections.

Antiphospholipid Antibody Syndrome

Antiphospholipid-antibody syndrome is a rare immune system characterized by

the presence of certain abnormal proteins in the blood. Antiphospholipid

antibodies interfere with the normal function of blood vessels.

Certain infections and medications can result in the production of these

proteins, which can increase the risk of blood clots.

Antiphospholipid-antibody syndrome can be associated with blood clots in the

legs and lungs, migraines, miscarriages, strokes and other blood disorders.

Aplastic Anemia

Secondary aplastic anemia results from injury to stem cells. Normal stem

cells divide and differentiate into all blood cell types.

Thus, when stem cells are injured, there is a reduction in red blood cells,

white blood cells, and platelets.

This condition can be caused by chemotherapy, drug therapy to suppress the

immune system, radiation therapy, toxins such as benzene or arsenic, drugs,

pregnancy, and congenital disorders.

Immunohemolytic (Coombs-positive) Anemia

Hemolytic anemia is a term used for a variety of anemias characterized by a

low count of red blood cells. Hemolytic anemia occurs when red blood cells

are destroyed faster than bone marrow can produce them.

The term for destruction of red blood cells is " hemolysis. "

Immunohemolytic (coombs-positive) anemia is the destruction of red blood

cells due to an inappropriate attack on the red blood cells by cells of the

immune system.

Caput Medusae

Caput medusae are dilated veins seen on the lower abdomen of patients with

cirrhosis of the liver.

Cirrhosis impairs blood flow through the liver, causing increased pressure

in the portal system (portal hypertension). The increased blood pressure

can be transmitted to collateral veins in the abdomen, causing the formation

of visible varicose veins in the lower abdomen.

Cryoglobulinemia

The symptoms associated with cryoglobulinemia occur when the cryoglobins are

exposed to cold temperatures and precipitate, or clump together.

The precipitated immunoglubulins are large enough to block off small

arteries and capillaries in the extremities.

The presence of the cryoglobin clusters can act as a direct irritant on the

lining of arteries and veins, causing an inflammation of blood vessels

called vasculitis.

In cryoglobulinemia associated with HCV infection, the vasculitis typically

involves the smaller blood vessels of the skin, kidneys, and

gastrointestinal tract.

For references, see the article Cryoglobulinemia and Hepatitis C Infection.

Hyperlipasemia

Lipase is an enzyme, secreted by the pancreas and small intestine that

breaks down fats into glycerol and fatty acids during digestion.

Hyperlipasemia is a condition in which the level of lipase in the blood is

higher than normal.

Greater-than-normal levels suggest pancreatitis, pancreatic cancer or

cholecystitis.

Idiopathic Thrombocytopenic Purpura (See Skin Disorders)

Porphyria Cutanea Tarda

Porphyria is a group of at least eight diseases caused by abnormalities in

the chemical steps that lead to heme production.

Found mostly in the blood, bone marrow, and liver, heme is a vital molecule

for all of the body's organs.

Heme is a component of hemoglobin, the molecule that carries oxygen in the

blood. Porphyria cutanea tarda is the most common type of porphyria.

Signs and symptoms usually begin in adulthood and result from the skin

becoming overly sensitive to sunlight.

Areas of skin exposed to the sun develop severe blistering, scarring,

changes in pigmentation; increased hair growth and is easily damaged.

People with porphyria cutanea tarda also have increased iron levels in the

liver. They face a higher risk of developing abnormal liver function and

liver cancer.

The signs and symptoms of this condition are triggered by nongenetic factors

such as alcohol abuse, excess iron, certain hormones, and viral infections.

Raynaud's Syndrome

Raynaud's phenomenon is a disorder that affects the blood vessels in the

fingers, toes, ears, and nose.

This disorder is characterized by episodic attacks, called vasospastic

attacks that cause the blood vessels in the digits (fingers and toes) to

constrict (narrow).

Raynaud's phenomenon can occur on its own, or it can be secondary to another

condition such as scleroderma or lupus.

An attack is usually triggered by exposure to cold or emotional stress. In

general, attacks affect the fingers or toes but may affect the nose, lips,

or ear lobes.

Spider Nevi (Spider Angioma)

Spider angioma is an abnormal collection of blood vessels near the surface

of the skin. The appearance is often similar to that of a small spider web.

A spider angioma lesion typically has a red dot in the center with reddish

extensions radiating out for some distance around it (a few millimeters to a

centimeter or more).

Spider angiomas can occur anywhere but are most common on the face and

trunk, and are very common during pregnancy and in patients with liver

disease.

A colloquial term for spider nevi is " gin blossom. "

Thrombocytopenia

Thrombocytopenia is a disorder in which the number of platelets (a type of

blood cell) is abnormally low, sometimes associated with abnormal bleeding.

Platelets are cells in the blood that help blood to clot. Thrombocytopenia

refers to any disorder in which there are not enough platelets.

Thrombocytopenia can also be associated with cancers of the blood and with

disorders that cause bone marrow dysfunction.

Symptoms can include bruising, nosebleeds or oral bleeding, and petechial

rash (pinpoint red spots).

Other symptoms may be present as well, depending on the cause of the

condition. Mild thrombocytopenia can occur without symptoms.

Cardiac Disorders

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a form of cardiomyopathy (disease of

the heart muscle) involving enlargement and thickening of the heart muscle.

The thickening is often not symmetrical, affecting one part of the heart

more than others. It may interfere with the functioning of the heart by

reducing the size of the ventricular chamber.

It may also reduce the ability of the valves to work properly. The

enlargement may, in some circumstances, obstruct the flow of blood out of

the heart.

Cancers

B-cell Lymphoma

Burkitt (b-cell) lymphoma is a lymph gland tumor classified as a

non-Hodgkin's type of lymphoma. Lymphoma is a malignancy (cancer) of lymph

tissue found in the lymph nodes, spleen, liver, and bone marrow.

The first sign of this cancer is often an enlarged lymph node which appears

without a known cause.

The disease can spread to adjacent lymph nodes and later may spread outside

the lymph nodes to the lungs, liver, or bone marrow.

Cholangiocarcinoma

Cholangiocarcinoma is a malignant (cancerous) growth in one of the ducts

that carries bile from the liver to the small intestine.

A cholangiocarcinoma can arise anywhere along the liver secretion (biliary)

ducts. These tumors produce symptoms by blocking the bile ducts.

They affect both sexes, and a majority of cases are found in patients above

the age of 65.

Head and Neck Squamous-Cell Carcinoma

Squamous cell carcinoma (cancer) is a malignant tumor that affects the

middle layer of the skin.

It is more aggressive than basal cell cancer, but still may be relatively

slow-growing. It is more likely than basal cell cancer to spread

(metastasize) to other locations, including internal organs.

In the context of hepatitis C infection, squamous cell carcinoma may be

consequence of the development of lichen planus.

Hepatocellular Carcinoma

Liver cancer, also called hepatocellular carcinoma or malignant hepatoma, is

a primary liver cancer that originates in the hepatocytes (liver cells).

Hepatocellular carcinoma is a tumor that is relatively uncommon in the

United States, although its incidence is rising, principally in relation to

the spread of hepatitis C infection.

When liver cancer metastasizes, the cancer cells tend to spread to nearby

lymph nodes and to the bones and lungs.

Multiple Myeloma

Multiple myeloma is a cancer of the plasma cells in bone marrow,

characterized by the excessive growth and malfunction of plasma cells in the

bone marrow.

The growth of these extra plasma cells interferes with the production of red

blood cells, white blood cells, and platelets. This causes anemia,

susceptibility to infection, and increased tendencies toward bleeding.

As the cancer cells grow and expand in the bone marrow, they also cause pain

and destruction of the bones.

If the bones in the spine are affected, compression of the nerves may result

causing numbness or paralysis.

Non-Hodgkin's Lymphoma

Non-Hodgkin's lymphomas are cancers of lymphoid tissue (lymph nodes, spleen,

and other organs of the immune system).

Non-Hodgkin's lymphomas can be slow-growing ( " low-grade " ) or rapidly growing

( " high-grade " ) cancer.

For most patients, the cause is unknown, but lymphomas can develop in people

with a suppressed immune system, such as after organ transplantation.

Digestive and Biliary System Disorders

Biliary Cirrhosis

Primary biliary cirrhosis is a liver disease that slowly destroys the bile

ducts in the liver.

Bile is a substance that helps digest fat, is produced in the liver, and

leaves the liver through these ducts.

When the ducts are damaged, bile builds up in the liver and damages liver

tissue, causing cirrhosis.

Celiac Disease (Sprue)

Celiac disease is an inherited, autoimmune disease.

The lining of the small intestine is damaged in response to ingestion of

gluten and other proteins found in wheat, barley, rye, possibly oats, and

their derivatives.

The exact cause of celiac disease is unknown. The symptoms of celiac

disease can vary significantly from person to person.

A partial listing of symptoms includes abdominal pain, abdominal distention,

bloating, gas, indigestion, constipation, decreased appetite, diarrhea,

lactose intolerance, nausea and vomiting, stools that float, are foul

smelling, bloody, or " fatty, " and unexplained weight loss.

Esophageal Varices

Varices are veins which have been stretched and distorted by the increased

pressure of blood diverted form the portal vein.

Although esophageal varices are often discussed as a complication of liver

disease, varices can also develop in the stomach and rectum.

Any cause of chronic liver disease can cause bleeding varices. Varices are

thin-walled and under high blood pressure and bleeding is a common problem.

Hemosiderosis / Hemochromatosis (Iron Storage Disease)

Hemosiderosis is the presence of increased amounts of iron in tissues

( " iron-rich foci " ).

When the suplus iron deposition is associated with tissue injury, the

disease state is called hemochromatosis.

Hemochromatosis is the most common form of iron overload disease, in which

the body absorbs and stores too much iron.

The extra iron builds up in organs and damages them. Without treatment, the

disease can cause these organs to fail.

Joint pain is the most common complaint of people with hemochromatosis.

Other common symptoms include fatigue, lack of energy, abdominal pain, loss

of sex drive, and heart problems.

Pancreatitis

Pancreatitis is an inflammation or infection of the pancreas, an elongated,

tapered gland located behind the stomach.

The pancreas secretes digestive enzymes and the hormones insulin and

glucagon.

The various types of pancreatitis involve irritation, inflammation, and

infection of the pancreas. The disorders differ according to whether

symptoms develop suddenly or slowly.

Specific types of pancreatitis are chronic pancreatitis, acute pancreatitis

and pancreatic abscess.

Spontaneous Bacterial Peritonitis

Peritonitis is an inflammation of the peritoneum, which is the membrane that

lines the wall of the abdomen and covers the organs.

Spontaneous peritonitis is an infection that occurs as a complication of

ascites (a collection of fluid in the peritoneal cavity), which is usually

related to liver or kidney failure.

Most cases of bacterial peritonitis occur either when fluid accumulates in

the peritoneal cavity (ascites) because of chronic liver disease, or in

kidney failure patients undergoing peritoneal dialysis.

Risk factors for liver disease include alcoholic cirrhosis and other

diseases that lead to cirrhosis, such as viral hepatitis.

Kidney Disorders

Glomerulonephritis

Glomerulonephritis is a type of kidney disease caused by inflammation of the

internal kidney structures (glomeruli).

Glomerulonephritis may be a temporary and reversible condition, or it may be

progressive.

Progressive glomerulonephritis may result in destruction of the kidney

glomeruli and chronic renal failure and end stage renal disease.

The disease may be caused by specific problems with the body's immune

system, but the precise cause of most cases is unknown.

Damage to the glomeruli with subsequent impaired filtering causes blood and

protein to be lost in the urine.

Because symptoms develop gradually, the disorder may be discovered when

there is an abnormal urinalysis during routine physical or examination for

unrelated disorders.

Glomerulonephritis can cause hypertension and may only be discovered as a

cause of hypertension that is difficult to control.

Membranoproliferative Glomerulonephritis

Membranoproliferative glomerulonephritis is a form of glomerulonephritis

caused by an abnormal immune response, with deposits of antibodies in the

internal kidney structures (glomeruli).

The glomerular membrane disruption causes a change in urine filtration,

making the glomerulus permeable to protein and blood cells.

This is manifested as acute nephritic syndrome, nephrotic syndrome, or

abnormal urinalysis without symptoms. Urine output decreases because of

reduced glomerular filtration rate.

Swelling may occur as sodium and water are retained in the body.

Protein in the bloodstream keeps fluid within the blood vessels. Edema is

increased when protein is lost because fluid leaks out of blood vessels into

the tissues.

Hypertension occurs due to the cumulative effects of water and sodium

retention and increased production of renin (a hormone that regulates blood

pressure) by the damaged kidney.

Nitrogenous waste products such as urea (BUN) and creatinine may accumulate

in the blood (azotemia) because of poor kidney functioning. The disorder is

often progressive and eventually results in chronic renal failure.

Hepatorenal Syndrome

Hepatorenal syndrome occurs when there is a decrease in kidney function in a

person with a liver disorder.

The most common symptom is decreased urine production. As a result of

reduced elimination of urine, nitrogen-containing waste products accumulate

in the blood stream (azotemia).

The exact cause of hepatorenal syndrome is unknown. For some reason, there

is drastic reduction in blood flow to the kidneys.

The kidney structure remains essentially normal and the kidneys often will

instantly function well if the liver disease is corrected (for example, by

liver transplantation).

The disorder occurs in up to 10% of patients hospitalized with liver

failure.

It may be a sign of impending death caused by the accumulated effects of

liver damage and kidney failure in people with acute liver failure,

cirrhosis or alcoholic hepatitis.

It is diagnosed when other causes of kidney failure are ruled out.

Lung Disorders

Pulmonary Fibrosis

Pulmonary fibrosis involves scarring or thickening of tissues deep in the

lung without a known cause.

Pulmonary fibrosis damages the air sacs (alveoli) and leads to reduced

transfer of oxygen to the blood, resulting in shortness of breath on

exertion, decreased tolerance for activity, cough (usually dry), and chest

pain.

When the cause of pulmonary fibrosis is unknown, the disease is described as

idiopathic.

Metabolic and Hormonal Disorders

Diabetes

Diabetes is a life-long disease marked by high levels of sugar in the blood.

It can be caused by too little insulin (a hormone produced by the pancreas

to regulate blood sugar), resistance to insulin, or both.

In Type 1 diabetes, the body makes little or no insulin, and daily

injections of insulin are required to sustain life.

In Type 2 diabetes, the pancreas does not make enough insulin to keep blood

glucose levels normal, often because the body does not respond well to the

insulin.

High blood levels of glucose can cause several problems, including frequent

urination, excessive thirst, hunger, fatigue, weight loss, and blurry

vision.

However, because type 2 diabetes develops slowly, some people with high

blood sugar experience no symptoms at all.

Patients with type 1 diabetes usually develop symptoms over a short period

of time, and the condition is often diagnosed in an emergency setting.

Gynecomastia

Gynecomastia is the formation of abnormal breast tissue in males.

The condition may occur in one or both breasts and begins as a small lump

beneath the nipple, which may be tender. The breasts often enlarge unevenly.

Apart from puberty, causes of gynecomastia include chronic liver disease,

kidney failure, and exposure to estrogens, androgens (often taken secretly

for body building), marijuana, and some medications.

Rare causes include tumors, genetic defects, or an overactive thyroid.

Testicular Atrophy / Hypogonadism

Testicular atrophy is a term used to describe the shrinking of testicles.

Hypogonadism is a reduced or absent secretion of hormones from the sex

glands (gonads). In men, these are the testes; in women, the ovaries.

The cause of hypogonadism may be " primary " or " central. " In primary

hypogonadism, the ovaries or testes themselves do not function properly.

Some causes include surgery; radiation; genetic and developmental disorders;

liver and kidney disease; infection; and certain autoimmune disorders.

In girls, hypogonadism during childhood will result in lack of menstruation

and breast development and short height. If hypogonadism occurs after

puberty, symptoms include loss of menstruation, low libido, hot flashes, and

loss of body hair.

In boys, hypogonadism in childhood results in lack of muscle and beard

development and growth problems. In men the usual complaints are sexual

dysfunction, decreased beard and body hair, breast enlargement, and muscle

loss.

Thyroid Disease

The thyroid gland is located in the base of the neck on both sides of the

lower part of the larynx and upper part of the trachea.

The gland produces thyroid hormone in response to stimulation by a hormone

from the pituitary gland. Thyroid hormone acts throughout the body to

regulate the metabolism of the cells.

Hyperthyroidism or thyrotoxicosis occurs when the thyroid releases too many

of its hormones over a short (acute) or long (chronic) period of time.

Many diseases and conditions can cause this problem.

Symptoms can include weight loss, increased appetite, nervousness,

restlessness, heat intolerance, increased sweating, fatigue, frequent bowel

movements, menstrual irregularities and goiter (visibly enlarged thyroid).

Hypothyroidism, or underactivity of the thyroid gland, may cause a variety

of symptoms and may affect all body functions.

The body's normal rate of functioning slows, causing mental and physical

sluggishness.

The symptoms may vary from mild to severe, with the most severe form called

myxedema, which is a medical emergency.

Muscle and Bone Disorders

Arthralgia

Arthralgia is pain affecting one or more joints. Arthralgia is commonly

associated with arthritis, discussed below.

Arthritis (Osteoarthritis and Rheumatoid Arthritis)

Arthritis involves inflammation of one or more joints and the breakdown of

cartilage.

Cartilage normally protects the joint, allowing for smooth movement.

Cartilage also absorbs shock when pressure is placed on the joint. Without

the usual amount of cartilage, the bones rub together, causing pain,

swelling, and stiffness.

With some injuries and diseases, the inflammation does not go away or

destruction results in long-term pain and deformity; this is called chronic

arthritis.

Osteoarthritis is a chronic disease causing deterioration of the joint

cartilage (the softer parts of bones, which cushion their connections to

each other) and the formation of new bone (bone spurs) at the margins of the

joints.

For most people, the cause of osteoarthritis is unknown, but metabolic,

genetic, chemical, and mechanical factors play a role in its development.

Rheumatoid arthritis is a chronic (long-term) inflammatory disease that

primarily affects the joints and surrounding tissues, but can also affect

other organ systems.

The cause of rheumatoid arthritis (RA) is unknown. However, RA involves an

attack on the body by its own immune cells (see the section on auto-immune

diseases, above).

Fibromyalgia Syndrome

Fibromyalgia is a chronic pain illness which is characterized by widespread

musculoskeletal aches, pain and stiffness, soft tissue tenderness, general

fatigue and sleep disturbances.

The most prominent symptom of fibromyalgia is pain, commonly located in the

neck, shoulders, back, and hips.

Unlike arthritis, the discomfort is not in the joints but in the muscles and

ligaments.

Hepatic Osteodystrophy

Hepatic osteodystrophy is a generic definition for the metabolic bone

disease that may occur in individuals with chronic liver disease, involving

two distinct processes, osteoporosis (the loss of bony tissue) and

osteomalacia (softening of the bones).

Hepatic osteodystrophy is a common complication among individuals with long

time lasting hepatic disease, particularly those with cholestasis (reduced

or stopped bile flow).

Hepatitis C-Associated Osteosclerosis

Hepatitis C-associated osteosclerosis is a very rare disorder characterized

by a marked increase in bone mass.

Symptoms include diffuse but progressive bone pain, elevated serum alkaline

phosphatase (ALP) activity, and increased bone density.

Inflammatory Myositis and Myalgia

Myositis is an inflammation or swelling of the voluntary (skeletal) muscles.

Mylagia is another term for muscle pain.

Neurological Disorders

Leukoencephalopathy

Leukoencephalopathy is the destruction of the myelin sheaths which cover

nerve fibers and promote the transmission of nerve impulses.

Patients with this leukoencephalopathy may present with a variety of

clinical findings ranging mild confusion to lethargy, dysarthria, dysphasia,

ataxia, spasticity, or progressive dementia.

Paresthesia / Peripheral Neuropathy

Paresthesia refers to a burning or prickling sensation that is usually felt

in the hands, arms, legs, or feet, but can also occur in other parts of the

body.

The sensation, which happens without warning, is usually painless and

described as tingling or numbness, skin crawling, or itching.

Chronic paresthesia is often a symptom of an underlying neurological disease

or traumatic nerve damage.

Paresthesia can be caused by disorders affecting the central nervous system,

such as stroke and transient ischemic attacks (mini-strokes), multiple

sclerosis, transverse myelitis, and encephalitis.

A tumor or vascular lesion pressed up against the brain or spinal cord can

also cause paresthesia.

Nerve entrapment syndromes, such as carpal tunnel syndrome, can damage

peripheral nerves and cause paresthesia accompanied by pain.

Peripheral neuropathy describes damage to the peripheral nerves.

It may be caused by diseases of the nerves or as the result of systemic

illnesses. Many neuropathies have well-defined causes such as diabetes,

uremia, AIDs, or nutritional deficiencies.

In fact, diabetes is one of the most common causes of peripheral neuropathy.

Although the causes of peripheral neuropathy are diverse, they produce

common symptoms including weakness, numbness, paresthesia (abnormal

sensations such as burning, tickling, pricking or tingling) and pain in the

arms, hands, legs and/or feet.

Encephalopathy

Encephalopathy is a term for any diffuse disease of the brain that alters

brain function or structure.

Causes of encephalopathy include infectious disease, metabolic dysfunction,

brain tumor, toxic exposure, chronic progressive trauma, poor nutrition, or

lack of oxygen or blood flow to the brain, and more.

The hallmark of encephalopathy is an altered mental state.

Depending on the type and severity of encephalopathy, common neurological

symptoms are progressive loss of memory and cognitive ability, subtle

personality changes, inability to concentrate, lethargy, and progressive

loss of consciousness.

Other neurological symptoms may include involuntary twitching of a muscle or

group of muscles, rapid, involuntary eye movement, tremor, muscle atrophy

and weakness, dementia, seizures, and loss of ability to swallow or speak.

Skin Disorders

Acral Necrolytic Erythema

Necrolytic acral erythema is a rash located exclusively on the acral areas

(the extremities of peripheral body parts), and is strongly association with

hepatitis C infection.

The rash appears as erythematous (reddened) patches with darkened borders,

loose blisters with erosions.

Erythema Multiforme

Erythema multiforme is a type of hypersensitivity (allergic) reaction that

occurs in response to medications, infections, or illness.

Erythema multiforme may present with a classic skin lesion with or without

systemic (whole body) symptoms.

In s- syndrome, the systemic symptoms are severe and the

lesions are extensive, involving multiple body areas (especially the mucous

membranes).

Toxic epidermal necrolysis (TEN syndrome, or Lyell's syndrome) involves

multiple large blisters (bullae) that coalesce, followed by sloughing of all

or most of the skin and mucous membranes.

Palmar Erythema

Palmar erythema is a reddening of the palms of the hands. Sometimes the

soles of the feet are often also affected.

Also known as " liver palms, " palmar erythema has been attributed to high

estrogen levels.

Thrombocytopenic Purpura

Thrombocytopenic purpura is a bleeding disorder characterized by too few

platelets in the blood.

This is because platelets are being destroyed by the immune system. The

disease occurs when immune system cells, called lymphocytes, produce

antibodies against platelets.

When the cause is unknown, the condition is called Idiopathic

Thrombocytopenic Purpura (ITP).

Platelets are necessary for normal blood clotting. They clump together to

plug small holes in damaged vessels.

The presence of antibodies on platelets leads to their destruction in the

spleen.

A characteristic skin rash, easy bruising, abnormal menstrual bleeding, or

sudden and severe loss of blood from the gastrointestinal tract may occur.

Lichen Planus

Lichen planus is an uncommon disorder involving a recurrent, itchy,

inflammatory rash or lesion on the skin or in the mouth. The exact cause is

unknown, but the disorder is likely to be related to an allergic or immune

reaction.

The disorder has been known to develop after exposure to potential allergens

such as medications, dyes, and other chemical substances.

Symptoms are increased with emotional stress, possibly because of changes in

immune system during stress.

Symptoms include itching in the location of a lesion, skin lesions located

on the inner areas of the wrist, legs, torso, or genitals, ridges in the

nails, dry mouth, metallic taste in the mouth, mouth lesions and hair loss.

Papular Acrodermatitis (Gianotti-Crosti disease)

Acrodermatitis is a skin condition peculiar to children that may be

accompanied by mild symptoms of fever and malaise.

It may also be associated with Hepatitis B and other viral infections. The

mechanism that causes acrodermatitis is poorly understood, but its

association with other infections is well documented.

The lesions of acrodermatitis appear as small coppery-red, flat-topped firm

papules that appear in crops and sometimes in long linear strings.

The lesions are often symmetric (equal on both sides) and appear on the

face, arms and legs, and buttocks. T

his is one of the few rashes that may also appear on the palms and soles.

Generalized enlargement of the lymph nodes and liver may be seen.

In Italian children, acrodermatitis is seen frequently in conjunction with

Hepatitis B, but this association is rarely seen in the USA.

In addition to Hepatitis B, acrodermatitis has also been associated with

Epstein-Barr virus infections (EBV, mononucleosis), cytomegalovirus,

coxsackie viruses, parainfluenza virus, respiratory syncytial virus (RSV),

and some live virus vaccines.

Pruritus (Itching) and Urticaria (Skin Rash)

Pruritus is an itching sensation that triggers the desire to scratch. It is

a distressing symptom that can cause discomfort.

Scratching may cause breaks in the skin that may result in infection.

Pruritus can be related to anything from dry skin to undiagnosed cancer.

Pruritus is a symptom, not a diagnosis or disease.

Rashes involve changes in the color or texture of skin. Often, the cause of

a rash can be determined from its visible characteristics and other

symptoms.

A simple rash is called dermatitis, meaning inflammation of the skin.

Contact dermatitis is caused by things your skin touches, such as dyes and

other chemicals in clothing, chemicals in elastic, latex, and rubber

products, cosmetics, soaps, detergents, poison ivy, oak, or sumac.

Seborrheic dermatitis is a rash that appears in patches of redness and

scaling around the eyebrows, eyelids, mouth, nose, the trunk, and behind the

ears.

If it happens on your scalp, it is called dandruff in adults and cradle cap

in infants.

Many medical conditions can cause a rash, such as lupus erythematosus,

rheumatoid arthritis, especially the juvenile type, and kawasaki disease.

Vision Disorders

n's Corneal Ulcer

n's Ulcer is a chronic superficial ulcer of the cornea with a

undermined border.

It is progressive, painful, and may involve the entire cornea of the eye.

+++

V.J. is a Registered Nurse with a Bachelor's degree in Nursing and a

Master's degree in Clinical Psychology, and has experience in oncology,

critical care and hospice, nursing management, counseling and clinical

administration.

In this section, we list some studies that have examined the various

diseases associated with hepatitis C infection.

Autoimmune and Inflammatory Disorders

Behcet's Disease

a.. Sonmezoglu M, et al. Examination of the relationship between the

hepatitis C virus and Behcet's disease. J Dermatol 2004 May;31(5):442-3.

b.. Cesur S, et al. Prevalence of extrahepatic illnesses in patients with

chronic hepatitis b and hepatitis c: retrospective study of 435 patients.

Mikrobiyol Bul. 2003 Apr-Jun;37(2-3):187-93.

c.. Aksu K, et al. Prevalences of hepatitis A, B, C and E viruses in

Behcet's disease. Rheumatology (Oxford). 1999 Dec;38(12):1279-81.

Cerebral Vasculitis

a.. Arena MG, et al. Cerebral vasculitis in a patient with HCV-related

type II mixed cryoglobulinemia. J Investig Allergol Clin Immunol.

2003;13(2):135-6.

b.. Heckmann JG, et al. Neurological manifestations of chronic hepatitis

C. J Neurol. 1999 Jun;246(6):486-91.

Cutaneous Vasculitis

a.. Marcellin P, et al. Cryoglobulinemia with vasculitis associated with

hepatitis C virus infection. Gastroenterology. 1993 Jan;104(1):272-7.

b.. Karlsberg PL, et al. Cutaneous vasculitis and rheumatoid factor

positivity as presenting signs of hepatitis C virus-induced mixed

cryoglobulinemia. Arch Dermatol. 1995 Oct;131(10):1119-23.

c.. Cacoub P, et al. Cryoglobulinemia vasculitis. Curr Opin Rheumatol.

2002 Jan;14(1):29-35.

Polyarteritis Nodosa

a.. Amarapurkar DN, Amarapurkar AD. Extrahepatic manifestations of viral

hepatitis. Ann Hepatol. 2002 Oct-Dec;1(4):192-5.

b.. Nocente R, et al. HCV infection and extrahepatic manifestations.

Hepatogastroenterology. 2003 Jul-Aug;50(52):1149-54.

c.. Cohen P. Extrahepatic manifestations of hepatitis C virus. Presse

Med. 2000 Feb 5;29(4):209-14.

d.. Cacoub P, et al. Systemic vasculitis in patients with hepatitis C. J

Rheumatol. 2001 Jan;28(1):109-18.

e.. Quint L, et al. Hepatitis C virus in patients with polyarteritis

nodosa. Prevalence in 38 patients. Clin Exp Rheumatol. 1991

May-Jun;9(3):253-7.

f.. JM. Hepatitis C and the skin. Dermatol Clin. 2002

Jul;20(3):449-58.

Rheumatoid Arthritis

a.. Cesur S, et al. Prevalence of extrahepatic illnesses in patients with

chronic hepatitis b and hepatitis c: retrospective study of 435 patients.

Mikrobiyol Bul. 2003 Apr-Jun;37(2-3):187-93.

b.. Rosner I. The case for hepatitis C arthritis. Semin Arthritis Rheum.

2004 Jun;33(6):375-87.

c.. Masuko-Hongo K, et al. Virus-associated arthritis. Best Pract Res Clin

Rheumatol. 2003 Apr;17(2):309-18.

Sjogren's Syndrome / Sicca Syndrome

a.. Ohoka S, et al. Sialadenitis in patients with chronic hepatitis C is

not directly related to hepatitis C virus. Hepatol Res. 2003

Sep;27(1):23-29.

b.. Ramos-Casals M, et al. Viral etiopathogenesis of Sjogren's syndrome:

role of the hepatitis C virus. Autoimmun Rev. 2002 Aug;1(4):238-43.

c.. Chernetsova OV, et al. Sjogren's syndrome in chronic hepatitis C:

clinical features and diagnosis. Ter Arkh. 2003;75(4):33-7.

d.. Nocente R, et al. HCV infection and extrahepatic manifestations.

Hepatogastroenterology. 2003 Jul-Aug;50(52):1149-54.

e.. JM. Hepatitis C and the skin. Dermatol Clin. 2002

Jul;20(3):449-58.

Systemic Lupus Erythematosus

a.. Ramos-Casals M, et al. Hepatitis C virus infection mimicking systemic

lupus erythematosus: study of hepatitis C virus infection in a series of 134

Spanish patients with systemic lupus erythematosus. Arthritis Rheum. 2000

Dec;43(12):2801-6.

b.. Qin CL, et al. Analysis of clinical and immunological features of

patients with systemic lupus erythematosus complicated by hepatitis C virus

infection. Di Yi Jun Yi Da Xue Xue Bao. 2002 Oct;22(10):939-41.

Blood and Circulatory Disorders

Agranulocytosis

a.. Amarapurkar DN, Amarapurkar AD. Extrahepatic manifestations of viral

hepatitis. Ann Hepatol. 2002 Oct-Dec;1(4):192-5.

b.. Ramos-Casals M, et al. Severe autoimmune cytopenias in treatment-naive

hepatitis C virus infection: clinical description of 35 cases. Medicine

(Baltimore). 2003 Mar;82(2):87-96.

Antiphospholipid Antibody Syndrome

a.. Prieto J, et al. Anticardiolipin antibodies in chronic hepatitis C:

implication of hepatitis C virus as the cause of the antiphospholipid

syndrome. Hepatology. 1996 Feb;23(2):199-204.

b.. Calvo Romero JM, et al. Chronic hepatitis C virus positive hepatitis

and antiphospholipid syndrome. Gastroenterol Hepatol. 1998 Nov;21(9):437-8.

Aplastic Anemia

a.. Amarapurkar DN, Amarapurkar AD. Extrahepatic manifestations of viral

hepatitis. Ann Hepatol. 2002 Oct-Dec;1(4):192-5.

b.. Ramos-Casals M, et al. Severe autoimmune cytopenias in treatment-naive

hepatitis C virus infection: clinical description of 35 cases. Medicine

(Baltimore). 2003 Mar;82(2):87-96.

c.. Kryczka W, Kisiel E. Hematologic syndromes in hepatitis C virus

infection. Przegl Lek. 2000;57(11):672-5.

Immunohemolytic (Coombs-positive) Anemia

a.. Elhajj II. Chronic hepatitis C associated with Coombs-positive

hemolytic anemia. Hematol J. 2004;5(4):364-6.

b.. Srinivasan R. Autoimmune hemolytic anemia in treatment-naive chronic

hepatitis C infection. J Clin Gastroenterol. 2001 Mar;32(3):245-7.

c.. Moccia F, et al. Autoimmune hemolytic anemia in chronic hepatitis C

virus infection: an unusual extrahepatic autoimmune manifestation. Ann Ital

Med Int. 2001 Oct-Dec;16(4):203-4.

Caput Medusae

a.. Sato T. Cutaneous manifestations of liver cirrhosis. Nippon Rinsho.

1994 Jan;52(1):170-3.

b.. J. Caput medusae: peristomal varices. J ET Nurs. 1993

Sep-Oct;20(5):216-9.

Cryoglobulinemia

a.. For references, see the article Cryoglobulinemia and Hepatitis C

Infection.

Hyperlipasemia

a.. Yoffe B, et al. Hyperlipasemia associated with hepatitis C virus. Dig

Dis Sci. 2003 Aug;48(8):1648-53.

Porphyria Cutanea Tarda

a.. Sams H, et al. Porphyria cutanea tarda, hepatitis C, alcoholism, and

hemochromatosis: a case report and review of the literature. Cutis. 2004

Mar;73(3):188-90.

b.. Nocente R, et al. HCV infection and extrahepatic manifestations.

Hepatogastroenterology. 2003 Jul-Aug;50(52):1149-54.

c.. Gisbert JP, et al. Prevalence of hepatitis C virus infection in

porphyria cutanea tarda: systematic review and meta-analysis. J Hepatol.

2003 Oct;39(4):620-7.

d.. Bauza A, et al. Porphyria cutanea tarda, dermatomyositis and

non-Hodgkin lymphoma in virus C infection. Eur J Dermatol. 2003

May-Jun;13(3):302-4.

e.. Rivanera D, et al. Hepatitis C virus in patients with porphyria

cutanea tarda: relationship to HCV-genotypes. New Microbiol. 1998

Oct;21(4):329-34.

f.. JM. Hepatitis C and the skin. Dermatol Clin. 2002

Jul;20(3):449-58.

Raynaud's Syndrome

a.. Iorio R, et al. Severe Raynaud's phenomenon with chronic hepatis C

disease treated with interferon. Pediatr Infect Dis J. 2003

Feb;22(2):195-7.

b.. Aprosina ZG, et al. Extrahepatic manifestations of chronic viral

liver diseases. Arkh Patol. 1999 Sep-Oct;61(5):51-5.

c.. Olesinska M, et al. Rheumatic syndromes during the course of HCV

infection. Pol Merkuriusz Lek. 2002 Feb;12(68):119-21.

Spider Nevi (Spider Angioma)

a.. Albrecht G. Skin manifestations of alcoholic liver damage. Ther Umsch.

2000 Apr;57(4):232-5.

b.. Pirovino M, et al. Cutaneous spider nevi in liver cirrhosis: capillary

microscopical and hormonal investigations. Klin Wochenschr. 1988 Apr

1;66(7):298-302.

c.. Li CP, et al. Role of substance P in the pathogenesis of spider

angiomas in patients with nonalcoholic liver cirrhosis. Am J Gastroenterol.

1999 Feb;94(2):502-7.

Thrombocytopenia

a.. Amarapurkar DN, Amarapurkar AD. Extrahepatic manifestations of viral

hepatitis. Ann Hepatol. 2002 Oct-Dec;1(4):192-5.

b.. Medina J, et al. Hepatitis C virus-related extra-hepatic

disease--aetiopathogenesis and management. Aliment Pharmacol Ther. 2004 Jul

15;20(2):129-41.

c.. de Almeida AJ, et al. Hepatitis C virus-associated thrombocytopenia: a

controlled prospective, virological study. Ann Hematol. 2004

Jul;83(7):434-40. Epub 2004 Feb 13.

d.. Panzer S, Seel E. Is there an increased frequency of autoimmune

thrombocytopenia in hepatitis C infection? A review. Wien Med Wochenschr.

2003;153(19-20):417-20.

Cardiac Disorders

Hypertrophic Cardiomyopathy

a.. Teragaki M, et al. Prevalence of hepatitis C virus infection among

patients with hypertrophic cardiomyopathy. Heart Vessels. 2003

Sep;18(4):167-70.

b.. Matsumori A, et al. Hepatitis C virus from the hearts of patients with

myocarditis and cardiomyopathy. Lab Invest. 2000 Jul;80(7):1137-42.

c.. Takeda N. Cardiomyopathy: molecular and immunological aspects

(review). Int J Mol Med. 2003 Jan;11(1):13-6.

d.. Naruse TK, Inoko H. HLA and hepatitis C virus positive cardiomyopathy.

Nippon Rinsho. 2000 Jan;58(1):212-7.

Cancers

B-cell lymphoma

a.. Zuckerman E, et al. Hepatitis C virus infection in patients with

B-cell non-Hodgkin lymphoma. Ann Intern Med. 1997 Sep 15;127(6):423-8.

b.. Mizorogi F, et al. Hepatitis C virus infection in patients with B-cell

non-Hodgkin's lymphoma. Intern Med. 2000 Feb;39(2):112-7.

c.. Negri E, et al. B-cell non-Hodgkin's lymphoma and hepatitis C virus

infection: a systematic review. Int J Cancer. 2004 Aug 10;111(1):1-8.

Cholangiocarcinoma

a.. Yamamoto S, et al. Hepatitis C virus infection as a likely etiology of

intrahepatic cholangiocarcinoma. Cancer Sci. 2004 Jul;95(7):592-5.

b.. Donato F, et al. Intrahepatic cholangiocarcinoma and hepatitis C and B

virus infection, alcohol intake, and hepatolithiasis: a case-control study

in Italy. Cancer Causes Control. 2001 Dec;12(10):959-64.

c.. Polizos A, et al. Advanced intrahepatic cholangiocarcinoma in

hepatitis C virus-related decompensated cirrhosis: case report and review of

the literature. Eur J Gastroenterol Hepatol. 2003 Mar;15(3):331-4.

Head and Neck Squamous-Cell Carcinoma

a.. Fatahzadeh M, et al. Squamous cell carcinoma arising in an oral

lichenoid lesion. J Am Dent Assoc. 2004 Jun;135(6):754-9; quiz 796.

b.. Eisen D. The clinical features, malignant potential, and systemic

associations of oral lichen planus: a study of 723 patients. J Am Acad

Dermatol. 2002 Feb;46(2):207-14.

c.. Porter SR, et al. Development of squamous cell carcinoma in hepatitis

C virus-associated lichen planus. Oral Oncol. 1997 Jan;33(1):58-9.

Hepatocellular Carcinoma

a.. Tagger A, et al. Case-control study on hepatitis C virus (HCV) as a

risk factor for hepatocellular carcinoma: the role of HCV genotypes and the

synergism with hepatitis B virus and alcohol. Brescia HCC Study. Int J

Cancer. 1999 May 31;81(5):695-9.

b.. Yotsuyanagi H, et al. Hepatitis C virus genotypes and development of

hepatocellular carcinoma. Cancer. 1995 Oct 15;76(8):1352-5.

c.. Dutta U, et al. Hepatocellular proliferation and development of

hepatocellular carcinoma: a case-control study in chronic hepatitis C. Hum

Pathol. 1998 Nov;29(11):1279-84.

Multiple Myeloma

a.. Montella M, et al. HCV and cancer: a case-control study in a

high-endemic area. Liver. 2001 Oct;21(5):335-41.

b.. Gharagozloo S, et al. Hepatitis C virus infection in patients with

essential mixed cryoglobulinemia, multiple myeloma and chronic lymphocytic

leukemia. Pathol Oncol Res. 2001;7(2):135-9.

c.. Paydas S, et al. Prevalence of hepatitis C virus infection in patients

with lymphoproliferative disorders in Southern Turkey. Br J Cancer. 1999

Jul;80(9):1303-5.

Non-Hodgkin's Lymphoma

a.. Paydas S, et al. Anti-HCV and HCV-RNA prevalence and clinical

correlations in cases with non-Hodgkin's lymphoma. Am J Hematol. 2003

Oct;74(2):89-93.

b.. Engels EA, et al. Hepatitis C virus infection and non-Hodgkin

lymphoma: results of the NCI-SEER multi-center case-control study. Int J

Cancer. 2004 Aug 10;111(1):76-80.

c.. Gisbert JP, et al. The prevalence of hepatitis C virus infection in

patients with non-Hodgkin's lymphoma. Eur J Gastroenterol Hepatol. 2004

Feb;16(2):135-8.

Digestive and Biliary System Disorders

Biliary Cirrhosis

a.. Floreani A, et al. Primary biliary cirrhosis and hepatitis C virus

infection. Am J Gastroenterol. 2003 Dec;98(12):2757-62.

b.. Caballeria L, et al. Hepatocellular carcinoma in primary biliary

cirrhosis: similar incidence to that in hepatitis C virus-related cirrhosis.

Am J Gastroenterol. 2001 Apr;96(4):1160-3.

c.. Floreani A, et al. Incidence of hepatic and extra-hepatic malignancies

in primary biliary cirrhosis (PBC). Ital J Gastroenterol. 1993

Nov-Dec;25(9):473-6.

Celiac Disease (Sprue)

a.. Fine KD, et al. Celiac sprue: another autoimmune syndrome associated

with hepatitis C. Am J Gastroenterol. 2001 Jan;96(1):138-45.

b.. Kaukinen K, et al. Celiac disease in patients with severe liver

disease: gluten-free diet may reverse hepatic failure. Gastroenterology.

2002 Apr;122(4):881-8.

c.. Morillas MJ, et al. Adult celiac disease and hepatopathy. Rev Esp

Enferm Dig. 1991 Mar;79(3):197-200.

Esophageal Varices

a.. Arguedas MR. The critically ill liver patient: the variceal bleeder.

Semin Gastrointest Dis. 2003 Jan;14(1):34-8.

b.. Odelowo OO, et al. Upper gastrointestinal bleeding in patients with

liver cirrhosis. J Natl Med Assoc. 2002 Aug;94(8):712-5.

Hemosiderosis / Hemochromatosis (Iron Storage Disease)

a.. Lefkowitch JH, et al. Iron-rich foci in chronic viral hepatitis. Hum

Pathol. 1998 Feb;29(2):116-8.

b.. Kaji K, et al. Hemosiderin deposition in portal endothelial cells: a

novel hepatic hemosiderosis frequent in chronic viral hepatitis B and C.

Hum Pathol. 1995 Oct;26(10):1080-5.

c.. Smirnov OA, et al. Liver hemosiderosis in chronic hepatitis. Arkh

Patol. 2003 Jan-Feb;65(1):39-42.

d.. Di Bisceglie AM, et al. Measurements of iron status in patients with

chronic hepatitis. Gastroenterology. 1992 Jun;102(6):2108-13.

Pancreatitis

a.. Amarapurkar DN, Amarapurkar AD. Extrahepatic manifestations of viral

hepatitis. Ann Hepatol. 2002 Oct-Dec;1(4):192-5.

b.. Alvares-Da-Silva MR, et al. Acute hepatitis C complicated by

pancreatitis: another extrahepatic manifestation of hepatitis C virus? J

Viral Hepat. 2000 Jan;7(1):84-6.

c.. Eugene C, et al. Acute pancreatitis associated with non-A-non-B

hepatitis. Report of a case. J Clin Gastroenterol. 1990 Apr;12(2):195-7.

Spontaneous Bacterial Peritonitis

a.. Fernandez J, et al. Bacterial infections in cirrhosis: epidemiological

changes with invasive procedures and norfloxacin prophylaxis. Hepatology.

2002 Jan;35(1):140-8.

b.. Llovet JM, et al. Spontaneous bacterial peritonitis in patients with

cirrhosis undergoing selective intestinal decontamination. A retrospective

study of 229 spontaneous bacterial peritonitis episodes. J Hepatol. 1997

Jan;26(1):88-95.

c.. Soriano G, et al. Selective intestinal decontamination prevents

spontaneous bacterial peritonitis. Gastroenterology. 1991

Feb;100(2):477-81.

Kidney Disorders

Glomerulonephritis

a.. Arase Y, et al. Glomerulonephritis in autopsy cases with hepatitis C

virus infection. Intern Med. 1998 Oct;37(10):836-40.

b.. Lopes LM, et al. revalence of hepatitis C virus antibodies in primary

glomerulonephritis in Brazil. Am J Nephrol. 1998;18(6):495-7.

c.. Altraif IH, et al. Hepatitis C associated glomerulonephritis. Am J

Nephrol. 1995;15(5):407-10.

Membranoproliferative Glomerulonephritis

a.. Yamabe H, et al. Hepatitis C virus infection and membranoproliferative

glomerulonephritis in Japan. J Am Soc Nephrol. 1995 Aug;6(2):220-3.

b.. Rostoker G, et al. Type I membranoproliferative glomerulonephritis and

HCV infection. Nephrol Dial Transplant. 1996;11 Suppl 4:22-4.

c.. Pasquariello A, et al. Cryoglobulinemic membranoproliferative

glomerulonephritis associated with hepatitis C virus. Am J Nephrol.

1993;13(4):300-4.

Hepatorenal Syndrome

a.. Cardenas A, Arroyo V. Hepatorenal syndrome. Ann Hepatol. 2003

Jan-Mar;2(1):23-9.

b.. Gines P, et al. Hepatorenal syndrome. Lancet. 2003 Nov

29;362(9398):1819-27.

c.. Praditpornsilpa K, et al. Hepatitis virus and kidney. Singapore Med

J. 1996 Dec;37(6):639-44.

Lung Disorders

Pulmonary Fibrosis

a.. Meliconi R, et al. Incidence of hepatitis C virus infection in Italian

patients with idiopathic pulmonary fibrosis. Thorax. 1996 Mar;51(3):315-7.

b.. Manganelli P, et al. Hepatitis C virus and pulmonary fibrosis.

Recenti Prog Med. 2002 May;93(5):322-6.

c.. Aisa Y, et al. Polymyositis, pulmonary fibrosis and malignant lymphoma

associated with hepatitis C virus infection. Intern Med. 2001

Nov;40(11):1109-12.

Metabolic Disorders

Diabetes

a.. Bahtiyar G, et al. Association of diabetes and hepatitis C infection:

epidemiologic evidence and pathophysiologic insights. Curr Diab Rep. 2004

Jun;4(3):194-8.

b.. Thuluvath PJ, PR. Association between hepatitis C, diabetes

mellitus, and race. a case-control study. Am J Gastroenterol. 2003

Feb;98(2):438-41.

c.. Brischetto R, et al. Prevalence and significance of type-2 diabetes

mellitus in chronic liver disease, correlated with hepatitis C virus. Ann

Ital Med Int. 2003 Jan-Mar;18(1):31-6.

Gynecomastia

a.. Islam N, et al. Cirrhosis of liver. Bangladesh Med Res Counc Bull.

1981 Dec;7(2):45-51.

b.. Pfeilschifter J. Disordered hormone regulation in gynecomastia.

Kongressbd Dtsch Ges Chir Kongr. 2002;119:743-7.

c.. Yoshitsugu M, et al. Endocrine disturbances in liver cirrhosis-focused

on sex hormones. Nippon Rinsho. 1997 Nov;55(11):3002-6.

d.. Cavanaugh J, et al. Gynecomastia and cirrhosis of the liver. Arch

Intern Med. 1990 Mar;150(3):563-5.

Testicular Atrophy / Hypogonadism

a.. Yoshitsugu M, et al. Endocrine disturbances in liver cirrhosis-focused

on sex hormones. Nippon Rinsho. 1997 Nov;55(11):3002-6.

b.. Morimoto I. Gonadal dysfunctions in liver cirrhosis. Nippon Rinsho.

1994 Jan;52(1):132-7.

c.. Islam N, et al. Cirrhosis of liver. Bangladesh Med Res Counc Bull.

1981 Dec;7(2):45-51.

Thyroid Disease

a.. Antonelli A, et al. Thyroid disorders in chronic hepatitis C. Am J

Med. 2004 Jul 1;117(1):10-3.

b.. Ganne- N, et al. Latent autoimmune thyroiditis in untreated

patients with HCV chronic hepatitis: a case-control study. J Autoimmun. 2000

Mar;14(2):189-93.

c.. Broussolle C, et al. Hepatitis C virus infection and thyroid diseases.

Rev Med Interne. 1999 Sep;20(9):766-73.

Muscle and Bone Disorders

Arthralgia / Arthritis (Osteoarthritis and Rheumatoid Arthritis)

a.. J, et al. Arthritis in patients with chronic hepatitis C virus

infection. J Rheumatol. 1999 Feb;26(2):420-4.

b.. Buskila D. Hepatitis C-associated arthritis. Curr Opin Rheumatol. 2000

Jul;12(4):295-9.

c.. Vassilopoulos D, Calabrese LH. Rheumatic manifestations of hepatitis C

infection. Curr Rheumatol Rep. 2003 Jun;5(3):200-4.

d.. Olivieri I, et al. Hepatitis C virus and arthritis. Rheum Dis Clin

North Am. 2003 Feb;29(1):111-22.

Fibromyalgia Syndrome

a.. Kozanoglu E, et al. Fibromyalgia syndrome in patients with hepatitis C

infection. Rheumatol Int. 2003 Sep;23(5):248-51. Epub 2003 Mar 18.

b.. Buskila D, et al. Fibromyalgia in hepatitis C virus infection. Another

infectious disease relationship. Arch Intern Med. 1997 Nov

24;157(21):2497-500.

c.. Goulding C, et al. Prevalence of fibromyalgia, anxiety and depression

in chronic hepatitis C virus infection: relationship to RT-PCR status and

mode of acquisition. Eur J Gastroenterol Hepatol. 2001 May;13(5):507-11.

d.. J, et al. Fibromyalgia-associated hepatitis C virus infection.

Br J Rheumatol. 1997 Sep;36(9):981-5.

Hepatic Osteodystrophy

a.. Idilman R, et al. Hepatic osteodystrophy: a review.

Hepatogastroenterology. 1997 Mar-Apr;44(14):574-81.

b.. Tsuneoka K, et al. Osteodystrophy in patients with chronic hepatitis

and liver cirrhosis. J Gastroenterol. 1996 Oct;31(5):669-78.

c.. Karan MA, et al. Osteodystrophy in posthepatitic cirrhosis. Yonsei Med

J. 2001 Oct;42(5):547-52.

Hepatitis C-Associated Osteosclerosis

a.. Khosla S, et al. Insulin-like growth factor system abnormalities in

hepatitis C-associated osteosclerosis. Potential insights into increasing

bone mass in adults. J Clin Invest. 1998 May 15;101(10):2165-73.

b.. Shaker JL, et al. Hepatitis C-associated osteosclerosis: late onset

after blood transfusion in an elderly woman. J Clin Endocrinol Metab. 1998

Jan;83(1):93-8.

c.. Diamond T, Depczynski B. Acquired osteosclerosis associated with

intravenous drug use and hepatitis C infection. Bone. 1996

Dec;19(6):679-83.

d.. Whyte MP, et al. Doubling skeletal mass during adult life: the

syndrome of diffuse osteosclerosis after intravenous drug abuse. J Bone

Miner Res. 1996 Apr;11(4):554-8.

Inflammatory Myositis and Myalgia

a.. Di Muzio A, et al. Hepatitis C virus infection and myositis: a virus

localization study. Neuromuscul Disord. 2003 Jan;13(1):68-71.

b.. Kase S, et al. Inclusion body myositis associated with hepatitis C

virus infection. Liver. 2001 Oct;21(5):357-60.

c.. Satoh J, et al. Necrotizing myopathy in a patient with chronic

hepatitis C virus infection: a case report and a review of the literature.

Intern Med. 2000 Feb;39(2):176-81.

Neurological Disorders

Leukoencephalopathy

a.. Heckmann JG, et al. Neurological manifestations of chronic hepatitis

C. J Neurol. 1999 Jun;246(6):486-91.

b.. Kamar N, et al. Reversible posterior leukoencephalopathy syndrome in

hepatitis C virus-positive long-term hemodialysis patients. Am J Kidney Dis.

2001 Apr;37(4):E29.

Paresthesia / Peripheral Neuropathy

a.. Paoletti V, et al. Peripheral neuropathy without cryoglobulinemia in

patients with hepatitis C virus infection. Panminerva Med. 2000

Sep;42(3):175-8.

b.. De o L, et al. Viral RNA in nerve tissues of patients with

hepatitis C infection and peripheral neuropathy. Muscle Nerve. 2003

Jan;27(1):102-4.

c.. Ripault MP, et al. Peripheral neuropathies and chronic hepatitis C: a

frequent association? Gastroenterol Clin Biol. 1998 Nov;22(11):891-6.

d.. Zaltron S, et al. High prevalence of peripheral neuropathy in

hepatitis C virus infected patients with symptomatic and asymptomatic

cryoglobulinaemia. Ital J Gastroenterol Hepatol. 1998 Aug;30(4):391-5.

e.. Heckmann JG, et al. Neurological manifestations of chronic hepatitis

C. J Neurol. 1999 Jun;246(6):486-91.

Encephalopathy

a.. Mullen KD. Newer aspects of hepatic encephalopathy. Indian J

Gastroenterol. 2003 Dec;22 Suppl 2:S17-20.

b.. Tandon BN. Hepatic encephalopathy syndromes. Indian J Gastroenterol.

2003 Dec;22 Suppl 2:S4-6.

c.. EA, Weissenborn K. Neurology and the liver. J Neurol Neurosurg

Psychiatry. 1997 Sep;63(3):279-93.

d.. Gerber T, Schomerus H. Hepatic encephalopathy in liver cirrhosis:

pathogenesis, diagnosis and management. Drugs. 2000 Dec;60(6):1353-70.

Skin Disorders

Acral Necrolytic Erythema

a.. el Darouti M, Abu el Ela M. Necrolytic acral erythema: a cutaneous

marker of viral hepatitis C. Int J Dermatol. 1996 Apr;35(4):252-6.

b.. Khanna VJ, et al. Necrolytic acral erythema associated with hepatitis

C: effective treatment with interferon alfa and zinc. Arch Dermatol. 2000

Jun;136(6):755-7.

c.. Hivnor CM, et al. Necrolytic acral erythema: response to combination

therapy with interferon and ribavirin. J Am Acad Dermatol. 2004 May;50(5

Suppl):S121-4.

Erythema Multiforme

a.. Daoud MS, et al. Chronic hepatitis C and skin diseases: a review.

Mayo Clin Proc. 1995 Jun;70(6):559-64.

b.. Calista D, Landi G. Lichen planus, erythema nodosum, and erythema

multiforme in a patient with chronic hepatitis C. Cutis. 2001

Jun;67(6):454-6.

c.. Hadziyannis SJ. Skin diseases associated with hepatitis C virus

infection. J Eur Acad Dermatol Venereol. 1998 Jan;10(1):12-21.

Thrombocytopenic Purpura

a.. Pockros PJ, et al. Immune thrombocytopenic purpura in patients with

chronic hepatitis C virus infection. Am J Gastroenterol. 2002

Aug;97(8):2040-5.

b.. Pawlotsky JM, et al. Hepatitis C virus infection and autoimmune

thrombocytopenic purpura. J Hepatol. 1995 Dec;23(6):635-9.

c.. Fujita H. Idiopathic thrombocytopenic purpura following viral

infection. Nippon Rinsho. 2003 Apr;61(4):650-4.

d.. JM. Hepatitis C and the skin. Dermatol Clin. 2002

Jul;20(3):449-58.

Lichen Planus

a.. Carrozzo M, et al. Hepatitis C virus infection in Italian patients

with oral lichen planus: a prospective case-control study. J Oral Pathol

Med. 1996 Nov;25(10):527-33.

b.. Chung CH, et al. Relationship of oral lichen planus to hepatitis C

virus in southern Taiwan. Kaohsiung J Med Sci. 2004 Apr;20(4):151-9.

c.. Klanrit P, et al. Hepatitis C virus infection in Thai patients with

oral lichen planus. Oral Dis. 2003 Nov;9(6):292-7.

d.. Nocente R, et al. HCV infection and extrahepatic manifestations.

Hepatogastroenterology. 2003 Jul-Aug;50(52):1149-54.

e.. JM. Hepatitis C and the skin. Dermatol Clin. 2002

Jul;20(3):449-58.

f.. Katta R. Lichen planus. Am Fam Physician. 2000 Jun 1;61(11):3319-24,

3327-8.

Papular Acrodermatitis (Gianotti-Crosti disease)

a.. Pyrsopoulos NT, Reddy KR. Extrahepatic manifestations of chronic viral

hepatitis. Curr Gastroenterol Rep. 2001 Feb;3(1):71-8.

b.. Colombo M, et al. Acute hepatitis B in children with papular

acrodermatitis. Pediatr Pathol. 1986;6(2-3):249-57.

c.. Lee S, et al. Gianotti-Crosti syndrome associated with hepatitis B

surface antigen (subtype adr). J Am Acad Dermatol. 1985 Apr;12(4):629-33.

d.. JM. Hepatitis C and the skin. Dermatol Clin. 2002

Jul;20(3):449-58.

Pruritus (Itching) and Urticaria (Skin Rash)

a.. Doria C, et al. Effect of molecular adsorbent recirculating system in

hepatitis C virus-related intractable pruritus. Liver Transpl. 2003

Apr;9(4):437-43.

b.. JM. Hepatitis C and the skin. Dermatol Clin. 2002

Jul;20(3):449-58.

c.. Zirwas MJ, Seraly MP. Pruritus of unknown origin: a retrospective

study. J Am Acad Dermatol. 2001 Dec;45(6):892-6.

d.. Bonacini M. Pruritus in patients with chronic human immunodeficiency

virus, hepatitis B and C virus infections. Dig Liver Dis. 2000

Oct;32(7):621-5.

e.. Paoletti V, et al. Prevalence and clinical features of skin diseases

in chronic HCV infection. A prospective study in 96 patients. Panminerva

Med. 2002 Dec;44(4):349-52.

f.. Hadziyannis SJ. Skin diseases associated with hepatitis C virus

infection. J Eur Acad Dermatol Venereol. 1998 Jan;10(1):12-21.

Vision Disorders

n's Corneal Ulcer

a.. Pluznik D, Butrus SI. Hepatitis C-associated peripheral corneal

ulceration: rapid response to intravenous steroids. Cornea. 2001

Nov;20(8):888-9.

b.. Moazami G, et al. Interferon treatment of n's ulcers associated

with hepatitis C. Am J Ophthalmol. 1995 Mar;119(3):365-6.

c.. SE, et al. n-type hepatitis C virus-associated corneal

ulceration. Ophthalmology. 1994 Apr;101(4):736-45.

+++

V.J. is a Registered Nurse with a Bachelor's degree in Nursing and a

Master's degree in Clinical Psychology, and has experience in oncology,

critical care and hospice, nursing management, counseling and clinical

administration.

http://www.hepatitisneighborhood.com/content/understanding_hepatitis/complic

ations_of_Hepatitis C_2051.aspx

October 29, 2006

wow, that was depressing, but its better to have too much info than to live with

your head in the sand,

thanks,

bob Larson <bobLists@...> wrote: