Extrahepatic Immunological Disorders May Be Caused by Hepatitis C

Hepatitis Weekly via Individual Inc. :
Peripancreatic adenopathy in chronic hepatitis C virus (HCV) is an important diagnostic sign and may indicate an involvement of hepatitis C in still unexplained extrahepatic immunological disorders.

"The association between an increase in lymph nodes and hepatitis C positivity on screening, and the negative response to this screening in chronic hepatitis B surface antigen (HBsAg) carriers, may not be merely expression of a non-specific inflammatory reaction to the infection and the viral hepatic location," researcher S. Neri et al. wrote ("Peripancreatic Lymphoadenopathy and Extrahepatic Immunological Manifestations in Chronic Hepatitis C," European Journal of Clinical Investigation, September 1996;26:665-667). "It may confirm the marked lymphotropism shown by the hepatitis C virus and indicate more complex immune system involvement, especially regarding the other coexisting signs of immune system involvement related to the presence of intrahepatic cellular aggregates detected in our study."

The cloning of hepatitis C virus (HCV) genome and the introduction of tests to detect serum antibodies against its structural and non-structural antigens have revealed that HCV is the most important viral agent in community-acquired and post-tranfusional non-A and non-B hepatitis. The use of molecular biology techniques, such as polymerase chain reaction (PCR), has located distinct areas in the genome of this single allele RNA virus. The heterogeneity in the nucleotide sequence of some of these gene regions (putative antigens in the NS5 core, etc.) has allowed this virus to be subdivided into at least four genotypes. Abdominal ultrasonography has revealed increases in the size of the pancreas, coeliu and hepatic hilum lymph nodes in acute viral hepatitis and in 80- to 90 percent of anti-HC-positive patients with chronic infection. Elevated titres of serum anti-HC antibodies have been observed in subjects with immune system disorders, such as mixed essential cryoglobulinemia and Sjorgren's syndrome.

In this study Neri et al. sought to determine the role of peripancreatic lymph node swelling in systemic immunological alterations during chronic HCV. The prospective study was carried out in a university hospital. Clinical, hematochemical and ultrasonographic findings in 182 patients were studied. Ultrasonography was performed by the same operator and the findings were evaluated blind without the operator knowing the clinical and hepatological parameters.

Hepatitis B virus (HBV) markers, anti-HCV antibodies, LKM1, cryogloblinemia, rheumatoid factor, and anti-tissue antibodies were determined. Liver biopsy was carried out in 43 of the 182 patients. One or two pathological peripancreatic lymph nodes (PLNs) were present in 30 of the 182 patients and, of the 30, 28 were anti-HCV positive. Only one patient in the non-PLN group was positive for anti-HCV, there being statistical significance between the PLN and non-PLN groups. In HCV-positive patients, extrahepatic immunological manifestations were observed (cryoglobulinemia; positivity to anti-smooth muscle, antinuclear and antimitochondrial antibodies; positivity to rheumatoid factor and LKM1). In five patients the presence of focal lymphocytic aggregates was detected by biopsy, whereas one patient presented typical ocular lesion of Mikuliez's syndrome. "Our results may confirm the marked lymphotropism shown by the HCV virus and indicate more complex immune system involvement, especially in view of the coexisting signs of immune system involvement related to the presence of intrahepatic cellular aggregates detected in our study," Neri et al. wrote. "We believe that the peripancreatic adenopathy in chronic HCV hepatitis is an important diagnostic sign and may indicate an involvement of the C virus in the still unexplained extrahepatic immunological disorders."

The corresponding author for this study is S. Neri, Istituto di Medicina Interna e Medicina d'Urgenza, Ospedale S. Marta, Via Clementi 36, 95124 Catania, Italy.
Source: Hepatitis Weekly

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