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Hepatitis C virus-induced glomerular disease and posterior reversible encephalopathy syndrome after liver transplant : case report and literature review
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Hepatitis C virus-induced glomerular disease and posterior reversible encephalopathy syndrome after liver transplant : case report and literature review
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Journal Article
Hepatitis C virus-induced glomerular disease and posterior reversible encephalopathy syndrome after liver transplant : case report and literature review
2019
Overview
Chronic hepatitis C virus (HCV) infection is associated with numerous extra- hepatic complications, including neurological and renal manifestations. We describe the case of a
67-year-old Caucasian man with HCV-associated cryoglobulinemic glomerulonephritis, cirrhosis, and hepatocellular carcinoma. The early posttransplant course was complicated by fibrosing
cholestatic hepatitis due to recurrent HCV in the graft (HCV RNA up to 44,944,438 IU/mL).
Proliferative glomerulonephritis (nephritic and nephrotic syndrome) with mixed cryoglobulinemia
(purpura) was also recorded. Seventy-two days after surgery, the patient presented with seizures
and arterial hypertension; brain magnetic resonance imaging indicated the diagnosis of posterior
reversible encephalopathy syndrome (PRES). PRES responded well to medical treatment with
complete resolution of neurological changes. Antiviral therapy (sofosbuvir and ribavirin, six
months) gave a sustained viral response with the improvement of cryoglobulinemic symptoms
(including glomerular disease). Repeat liver biopsy revealed the regression of cholestatic damage
and perisinusoidal fibrosis. The current follow-up shows stable chronic renal failure (serum
creatinine: 1.4 mg/dL) and mild nephritic syndrome. The impact of extrahepatic manifestations of
HCV on patient outcomes is highlighted from novel observational studies reporting a relationshipa diseases are underway
Publisher
Saudi Center for Organ Transplantation,Wolters Kluwer India Pvt. Ltd,Medknow Publications and Media Pvt. Ltd,Medknow Publications & Media Pvt. Ltd,Wolters Kluwer Medknow Publications
