Relapsing Polychondritis and Chronic Hepatitis C Virus Infection

Introduction

• Chronic hepatitis C virus infection is often associated with extra- hepatic manifestations, majority of which are immunologically mediated
• The well established associations of HCV infection are mixed Cryoglobulinemia, membranoproliferative glomerulonephritis, leukocytoclastic vasculitis, porphyria cutanea tarda, sialadenitis and antibody production like Rheumatoid factor
• Other possible associations have been reported like B-cell non- Hodgkin's lymphomas, autoimmune cytopenia, polyarteritis nodosa and autoimmune thyroiditis.¹
• There is one case report in the literature describing the possible association of HCV infection with Relapsing Polychondritis.²

Case Report

• We report a patient with chronic HCV infection who developed chondritis and scleritis
• A 56 year old AAM presented with two week history of worsening pain ad swelling of ears and pain with redness in the eyes associated with photophobia
• He denied shortness of breath, hoarseness of voice, sinus pain or arthralgia's

Examination and Management

Figure 1. Inflammation of Ear and Eye (click photos to zoom).

• ENT: There was diffuse erythema, swelling and tenderness of both ears sparing the non cartilaginous part
• Eye examination revealed scleritis with normal visual acuity
• He showed good initial response to the steroids but flares each time prednisone is tapered below the 15 mg/d
• He was referred to the liver clinic for HCV treatment

Labs

Conclusion

This case may represent a possible association of hepatitis C virus infection with relapsing polychondritis as response to the HCV treatment remains to be seen

References

1. D.Saadoun, L.H. Calabrese. Hepatitis c-associated mixed cryoglobulinemia Rheumatology 2007;46:1234-1242
2. Herrera I,Concha R. Relapsing polychondritis, chronic hepatitis C virus infection and mixed cryoglobulinemia Semin Arthritis Rheum.2004;388-403