The efficacy of long-term
interferon therapy for
chronic hepatitis C infection with symptomatic mixed
cryoglobulinemia has not clearly been defined. We describe a patient with
chronic hepatitis C, symptomatic mixed
cryoglobulinemia (
cutaneous vasculitis), and
membranoproliferative glomerulonephritis (MPGN) who responded clinically, biochemically, and virologically to a 1-year course of
interferon therapy.
Interferon side effects were minimal. Relapse occurred when
interferon was discontinued, and suppressive maintenance
interferon therapy was required for clinical, biochemical, and virologic remission. During the 5th year of maintenance
therapy, she developed potential side effects that necessitated discontinuation of
interferon treatment.
After treatment stoppage, a clinical, biochemical, and virologic remission was maintained for more than 1 year. However, the potential side effects, which included eye irritation,
arthralgias, myalgias,
fatigue,
insomnia,
memory loss, and depression, persisted. Ophthalmologic, rheumatologic, and neurologic evaluations were nondiagnostic. Psychometric testing revealed
dementia and
mood disorder. Because the disabling symptoms persisted after 9 months, a health-related quality of life assessment was carried out with the SF-36 survey. Compared with healthy individuals and patients with
chronic hepatitis C, our case had a lower health-related quality of life assessment on six out of seven scales and on four out of seven scales of the SF-36 survey, respectively. This case report indicates that long-term maintenance
interferon therapy was effective in the treatment of symptomatic mixed
cryoglobulinemia and its renal complications and resulted in a clinical, biochemical, and virologic sustained response. It is postulated that the side effects of long-term
interferon therapy in this setting may be problematic.