The British Journal of Rheumatology, Vol 36, 360-365, Copyright © 1997 by British Society for Rheumatology
C Ferri, L La Civita, P Fazzi, S Solfanelli, F Lombardini, E Begliomini, M Monti, G Longombardo, G Pasero and AL Zignego
A possible aetiopathogenetic role of hepatitis C virus (HCV) has been
reported in various immune-mediated disorders, such as mixed
cryoglobulinaemia, which may be complicated by interstitial lung
involvement; moreover, different viruses, including HCV, have been
correlated with idiopathic pulmonary fibrosis. Here, a cohort of eight
HCV-positive patients (M/F = 4/4, mean age 61 +/- 8 S.D. yr) with
interstitial lung fibrosis and a variable number of rheumatic disorders are
described. Interstitial lung involvement appeared medially 4.5 +/- 3.2 S.D.
yr after the clinical onset of chronic hepatitis. During the clinical
follow-up, some rheumatic symptoms were also recorded: articular
involvement (four patients): mild sicca syndrome (one patient); severe
polymyositis and cranial neuropathy (one patient); serum cryoglobulins
and/or autoantibodies (eight patients). In all patients, a moderate (four
patients) or severe (four patients) lung fibrosis was evaluated by means of
high-resolution computed tomography. The presence of parenchymal
radiotracer uptake on 67Ga scan (7/7 patients) and increased percentages of
neutrophils (4/4 patients) and lymphocytes (2/4) at bronchoalveolar lavage
suggested an active lung involvement. Different degrees of reduction of
single breath diffusing capacity for carbon monoxide (DLco) (mean value
57.6 +/- 15%, range 37- 80) were observed in all cases, while spirometric
abnormalities, consistent with a global restrictive pattern, were less
frequently found. In all cases, anti-HCV antibodies and HCV viraemia were
demonstrated: viral genome was also detected in peripheral lymphocytes from
4/4 subjects and in one case in lung biopsy specimens. A desquamative
interstitial pneumonia pattern was demonstrated in two cases by lung
biopsy. The present work supports the hypothesis that HCV chronic infection
could represent a trigger factor for interstitial lung fibrosis and various
rheumatic disorders.
ORIGINAL PAPERS
Interstitial lung fibrosis and rheumatic disorders in patients with hepatitis C virus infection
Rheumatology Unit, University of Pisa, Italy.
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