Autoimmune Manifestations Of Viral Hepatitis

Chronic viral hepatitis, both type B (3) and type C, has been associated with a spectrum of autoimmune phenomena. McMurray and Elbourne (4) summarized many of the reported autoimmune complications of HCV hepatitis (Table 1). Some of these HCV-related entities, such as membranous glomerulonephritis (GN) (5), cryoglobulinemia, and associated vasculitis (6-9), tend to improve following successful treatment and viral eradication. Among HBV-associated autoimmune phenomena, the HBV-related proteinuria (10) and polyarteritis nodosa (11-16) usually improve, following successful IFN antiviral therapy. Nevertheless, the opposite may also occur: Worsening of cryoglobulinemic neuropathy and fatal bleeding secondary to vasculitic gastritis occurred when IFN-a was given to a hepatitis C patient with highly symptomatic cryoglobulinemia (17), in whom steroids had not been tried before IFN. It is not clear whether corticosteroids should be started before, or along with, IFN in the patient with symptomatic cryoglobulinemia. In addition, HCV-associated thyroid disease (18-20) and lichen planus (21-23) may worsen or flare during IFN therapy. Thus, it would appear that autoimmune complications of chronic viral hepatitis pursue a variable course during IFN therapy, and that clinicians must approach each case individually.

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