A case of hepatitis C virus-associated mixed cryoglobulinemia treated with direct-acting antivirals

Abstract

A 79-year-old woman was diagnosed as chronic hepatitis C 25 years ago, and hepatitis C virus (HCV)-associated cryoglobulinemia-related nephropathy thereafter. To eliminate HCV and improve the symptoms of cryoglobulinemia, several kinds of interferon (IFN)-based therapies were tried. However, HCV was not elimi-nated from her serum, and she was followed up under palliative therapy. She was admitted to our hospital for the treatment of decompensated heart failure caused by the progression of renal dysfunction and proteinuria due to HCV-associated cryoglobulinemia. To control her fluid retention and improve her proteinuria by the re-duction of serum cryoglobulin, combination of plasma exchange and hemodialysis was started. The combination therapy reduced her systemic edema, fluid retention, proteinuria, and renal dysfunction, however, withdrawal of hemodialysis was not impossible. Thus, to cure the cryoglobulinemia and withdraw the hemodialysis, combi-nation therapy of daclatasvir and asunaprevir (DCV/ASV) was started, which was combined with the double filtration plasma exchange. Serum HCV-RNA was not detected at 2 weeks after the start of DCV/ASV. Renal dysfunction and proteinuria were remarkably improved after the start of DCV/ASV. Even after we stopped double filtration plasma exchange, her renal function gradually improved, and her serum HCV-RNA was not detected at 24 weeks after the treatment of DCV/ASV, indicating sustained viral response to HCV was con-firmed. We experienced a case of the chronic hepatitis C resistant to IFN-based therapy, who needs a hemo-dialysis due to HCV-associated cryoglobulinemia-related nephropathy. She was successfully treated by the therapy of IFN-free DAAs, and her renal dysfunction was markedly improved. This is a case report providing us the essential information suggesting that HCV-associated mixed cryoglobulinemia will be treated by IFN-free DAAs therapy.