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Hepatitis C's Other Symptoms

March 15, 2007

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Although most people with chronic Hepatitis C do not exhibit symptoms of the "silent" epidemic, a significant number will experience its impact in organs other than their liver. Learn how to recognize these lesser-known conditions to help in the early detection and treatment of Hepatitis C.

by Nicole Cutler, L.Ac.

Many people infected with the Hepatitis C virus have no symptoms. Even if the person has been infected with Hepatitis C for a long time, no symptoms of the disease may present themselves until cirrhosis has developed. When symptoms are present, they can range from mild to severe. The most common symptom of chronic Hepatitis C is fatigue. Additional common symptoms of Hepatitis C include:

· Intermittent abdominal pain
· Reduced appetite and weight loss
· Nausea or vomiting
· Depression
· Jaundice – yellowing of the skin or whites of the eyes
· Low-grade fever
· Muscle aches
· Pale or grey colored stool
· Dark urine
· Generalized itching
· Ascites
· Bleeding varices – dilated veins in the esophagus

Extrahepatic Manifestations
People with Hepatitis C may exhibit symptoms and signs of infection that manifest in organs other than the liver. Known as extrahepatic manifestations, or immune-complex mediated diseases, these symptoms arise from the immune system’s effort to fight off the infection. Chronic Hepatitis C infection leaves people vulnerable to the development of diseases involving the kidneys, the skin, eyes, joints, immune system and the nervous system. The occurrence of an extrahepatic manifestation does not correlate with the severity of the underlying liver disease. The following associated conditions are the most commonly seen as a result of liver disease:

1. Cryoglobulinemia – This condition is due to the presence of abnormal antibodies (called cryoglobulins) that come from Hepatitis C virus stimulation of lymphocytes (white blood cells). These antibodies can deposit in small blood vessels, thereby causing inflammation of the vessels (vasculitis) in tissues throughout the body. The skin, joints and kidneys (glomerulonephritis) are often targets of the vasculitis.

People with cryoglobulinemia can present a variety of symptoms, including weakness, joint pain or swelling (arthralgia or arthritis), and a raised, purple skin rash (palpable purpura) usually in the lower portion of the legs. As well, people may experience swelling of the legs and feet due to loss of protein in the urine from the kidney involvement and nerve pain (neuropathy). What is more, this vascular condition can spawn Raynaud’s phenomenon, in which the fingers and toes turn color (white, then purple, then red) and become painful in cold temperatures.

2. B-cell non-Hodgkin's lymphoma – This cancer of the lymph tissue is associated with the chronic Hepatitis C virus. Its cause is believed to be excessive stimulation by the Hepatitis C virus of B-lymphocytes, resulting in the abnormal reproduction of the lymphocytes. Most individuals with Hepatitis C virus-associated non-Hodgkin’s lymphoma will require standard anti-cancer therapies.

3. Porphyria cutanea tarda (PCT) – PCT is a skin condition characterized by the overproduction of enzymes involved in the manufacturing of blood. People with PCT often have blisters and vesicles form on the back of the hands, forearms and neck, as well as the face. Lesions develop in areas exposed to the sun or have sustained minor trauma. Increased facial hair and pigmentation changes are also common. Major risk factors for the development of PCT include excessive iron exposure, heavy alcohol use, and the use of estrogens.

4. Lichen planus – A skin condition, Lichen planus appears as shiny, flat-topped bumps that often have an angular shape. This rash can occur anywhere on the skin, but often favors the inside of the wrists and ankles, the lower legs, back and neck. The mouth, genital region, hair and nails are affected in some individuals. Thick patches may occur, especially on the shins. About 20 percent of those affected with lichen planus of the skin experience minimal symptoms and need no treatment. However, in many cases the itching can be constant and intense.

5. Diabetes mellitus – An increasingly common metabolic disorder, diabetes mellitus is characterized by resistance to insulin, the hormone that regulates the amount of sugar in your blood. The accompaniment of Hepatitis C with diabetes is strongly associated with advanced liver fibrosis or cirrhosis. People with cirrhosis are believed to have decreased hepatic uptake of glucose, along with reduced hepatic clearance of insulin, leading to high levels of insulin and, therefore, insulin resistance syndrome.

Other conditions noted to be associated with Hepatitis C infection, include:

· Thyroid disease
· Kidney disease, especially Membranoproliferative Glomerulonephritis (MPGN)
· Vitiligo
· Arthritis
· Sjogren’s syndrome
· Mooren’s ulcer
· Neuropathy

While Hepatitis C is perceived as a virus attacking only the liver, clinical practice proves that its ramifications extend beyond solitary hepatic involvement. Perhaps due to the liver’s involvement in nearly every aspect of health, Hepatitis C is a systemic problem. The wide range of possible manifestations of this virus should signal increased public education for earlier diagnosis and treatment of Hepatitis C. Additionally, understanding the commonality between conditions associated with Hepatitis C can help a person suffering with multiple ailments recognize the likely origin of their extrahepatic manifestations.

References:

www.aocd.org, Lichen Planus, American Osteopathic College of Dermatology, 2006.

www.ccjm.org, Hepatitis C Infection: A Systemic Disease with extrahepatic manifestations, Aman Ali, MD, Nizar N Zein MD, Cleveland Clinic Journal of Medicine, November 2005.

www.hcvadvocate.org, Extrahepatic Manifestations of Chronic Hepatitis C, Roderick Remoroza, MD, Herbert Bonkovsky, MD, Hepatitis C Support Project, 2003.

www.idph.state.il.us, Health Beat: Hepatitis C, Illinois Department of Public Health, 2006.

www.medicinenet.com, What Conditions Outside the Liver are Associated with Hepatitis C?, Tse-Ling Fong, MD, MedicineNet, Inc, 2006.

Posted by Editors at March 15, 2007 1:06 PM

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