Ongen B, Aksungar FB, Cicek B, Akyar I, Coskun A, Serteser M, Unsal I. Hepatitis C virus positive patient diagnosed after detection of atypical cryoglobulin. World J Clin Cases 2016; 4(3): 81-87 [PMID: 26989673 DOI: 10.12998/wjcc.v4.i3.81]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 16, 2016; 4(3): 81-87 Published online Mar 16, 2016. doi: 10.12998/wjcc.v4.i3.81
Hepatitis C virus positive patient diagnosed after detection of atypical cryoglobulin
Belkiz Ongen, Fehime Benli Aksungar, Bahattin Cicek, Isin Akyar, Abdurrahman Coskun, Mustafa Serteser, Ibrahim Unsal
Belkiz Ongen, Fehime Benli Aksungar, Isin Akyar, Abdurrahman Coskun, Mustafa Serteser, Ibrahim Unsal, Department of Biochemistry, Acibadem Labmed Clinical Laboratories, 34435 Istanbul, Turkey
Fehime Benli Aksungar, Abdurrahman Coskun, Mustafa Serteser, Ibrahim Unsal, Department of Biochemistry, Acibadem University, School of Medicine, 34435 Istanbul, Turkey
Bahattin Cicek, Department of Internal Medicine-Gastroenterology, Acibadem University, School of Medicine, 34435 Istanbul, Turkey
Isin Akyar, Department of Microbiology, Acibadem University, School of Medicine, 34435 Istanbul, Turkey
Author contributions: Ongen B, Aksungar FB, Cicek B, Serteser M and Akyar I conceived and gathered data for the case report; Cicek B obtained written informed consent from the patient; Coskun A and Unsal I were involved in literature search and data analysis; Ongen B and Aksungar FB wrote the manuscript; all authors reviewed and edited the manuscript and approved the final version of the manuscript.
Institutional review board statement: Acıbadem University School Of Medicine, Acıbadem Hospitals Review Board had approved the case for publication.
Informed consent statement: Written informed consent from the patient is obtained in the clinic.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Belkiz Ongen, MD, Department of Biochemistry, Acibadem Labmed Clinical Laboratories, Fahrettin Kerim Gökay Caddesi, No. 49 Altunizade, 34435 Istanbul, Turkey. belkiz.ongen@acibademlabmed.com.tr
Telephone: +90-505-8760202 Fax: +90-216-5443940
Received: August 7, 2015 Peer-review started: August 10, 2015 First decision: October 14, 2015 Revised: November 4, 2015 Accepted: December 3, 2015 Article in press: December 4, 2015 Published online: March 16, 2016 Processing time: 216 Days and 13.7 Hours
Abstract
A 60-year-old male patient presented with jaundice and dark urine for three days, icteric sclerae and skin rash on his legs for six months. Laboratory investigations revealed an atypical cryoglobulinemia with high hepatitis C virus (HCV)-RNA levels. Imaging studies showed cholestasis was accompanying HCV. Capillary zone electrophoresis using immunosubtraction method revealed a polyclonal immunoglobulin G and immunoglobulin A (IgA) monoclonal cryoglobulin and that IgA lambda was absent in immunofixation electrophoresis. After a liver biopsy, chronic hepatitis C, HCV related mixed cryoglobulinemia and cryoglobulinemic vasculitis were diagnosed and antiviral therapy was initiated. Our HCV patient presented with cryoglobulinemic symptoms with an atypical cryoglobulinemia that was detected by an alternative method: Immunosubtraction by capillary electrophoresis. Different types of cryoglobulins may therefore have a correlation with clinical symptoms and prognosis. Therefore, the accurate immunotyping of cryoglobulins with alternative methods may provide more information about cryoglobulin-generated pathology.
Core tip: We describe atypical IgA monoclonal cryoglobulinemia as the presenting symptom of chronic hepatitis C. Immunotyping of the cryoglobulin was performed with capillary zone electrophoresis with immunosubtraction method which is an alternative method to classical immunofixation electrophoresis. Accurate immunotyping of cryoglobulins with alternative method provide more information about cryoglobulin-generated pathology in atypical patients.
