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Presentation and outcome of gastrointestinal involvement in hepatitis C virus-related systemic vasculitis: a case–control study from a single-centre cohort of 163 patients
  1. Benjamin Terrier1,2,
  2. David Saadoun1,2,
  3. Damien Sène1,
  4. Sami Scerra1,
  5. Lucile Musset3,
  6. Patrice Cacoub1,2
  1. 1Department of Internal Medicine, Groupe Hospitalier Pitié-Salpétrière, Université Pierre et Marie Curie, Paris, France
  2. 2CNRS UMR 7211, Groupe Hospitalier Pitié-Salpétrière, Université Pierre et Marie Curie, Paris, France
  3. 3Department of Immunology, Groupe Hospitalier Pitié-Salpétrière, Université Pierre et Marie Curie, Paris, France
  1. Correspondence to Professor Patrice Cacoub, Department of Internal Medicine, Groupe Hospitalier Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France; patrice.cacoub{at}psl.aphp.fr

Abstract

Background During primary systemic vasculitides gastrointestinal (GI) involvement is associated with a poor outcome, leading to the use of immunosuppressive therapy. The significance of GI involvement during hepatitis C virus (HCV)-related systemic vasculitis has never been evaluated.

Objective To evaluate the significance of GI involvement during HCV-related systemic vasculitis in the antiviral therapy era.

Methods Data from 163 patients were retrospectively reviewed to describe the presentation and outcome of patients with HCV-related systemic vasculitis with GI involvement (GI+), and to compare them with patients without GI involvement (GI−).

Results GI manifestations were present in 12 (7.4%) patients. Abdominal pain was consistently present in GI+ patients, and half of patients presented with surgical abdomen and/or intestinal bleeding. GI+ compared to GI− patients had more frequent renal (75% vs 30%; p=0.003) and cardiac involvement (25% vs 2%; p=0.006), medium-vessel vasculitis (67% vs 22%; p=0.003) and higher mixed cryoglobulinaemia levels (2.2 g/l vs 1.2 g/l; p=0.07). After treatment, GI+ and GI− patients had similar rates of overall clinical response of the vasculitis and immunological and virological responses. HCV-MC vasculitis patients with GI involvement did not have poorer overall survival than those without.

Conclusion GI involvement is a rare manifestation of HCV-related vasculitis, associated with acute-onset and life-threatening manifestations. In contrast with primary vasculitides, GI+ patients do not seem to have poorer overall survival than GI− patients.

  • Hepatitis C virus
  • vasculitis
  • mixed cryoglobulinemia
  • gastrointestinal involvementcryoglobulinemia
  • gastrointestinal pathology
  • HCV

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Pitié Salpétrière, Paris.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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