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plab2005
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Dermatology
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10.11.05 (3 years ago)
#1
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A 45-year-old man is referred to you by his dermatologist for therapy. He was seen several weeks ago by the dermatologist for evaluation of recurrent purpuric lesions on his legs.
He has noted the lesions for the past 3 months, and other than some mild burning, the eruption is asymptomatic.
The patient denies other complaints, including arthralgias, myalgias, chest pain, and headaches.
His medical history includes a motorcycle accident in 1979 that necessitated several operations.
He believes that he was given several transfusions at that time.
He denies the use of illicit drugs, except for experimentation with marijuana during college.
Physical examination is normal, except for multiple small, palpable, purpuric lesions on his legs. No ulceration is present.
Skin biopsy specimen shows a leukocytoclastic vasculitis.
Results of laboratory tests include a positive hepatitis C antibody, a positive rheumatoid factor titer of 1:16, and a hepatitis C viral RNA load of 600,000 copies/mL.
Results of cryoglobulin testing are negative. A liver biopsy reveals periportal fibrosis with some bridging.
The most appropriate therapy for this patient is:
(A) Interferon and ribavirin
(B) Methotrexate and folic acid
(C) Prednisone and azathioprine
(D) Cyclophosphamide
(E) Intravenous immune globulin
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guest
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10.11.05 (3 years ago)
#2
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I think it should be interferon with ribavirin
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plab2005
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10.11.05 (3 years ago)
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Yes u r right
Interferon and ribavirin
This patient has hepatitis C–associated vasculitis probably has essential mixed cryoglobulinemia, despite the negative results of cryoglobulin testing.
The best therapy for this patient’s vasculitis and early changes of cirrhosis is interferon and ribavirin.
Although vasculitis may be treated with prednisolone, methotrexate, azathioprine, and cyclophosphamide, the use of these drugs may increase the viral load and result in progression of the liver disease.
Methotrexate has been used for some patients with small-vessel vasculitis, but it has been associated with the possible development of cirrhosis and is certainly not indicated in this patient, even with folic acid.
Cyclophosphamide and intravenous immunoglobulin are therapies that are far too aggressive for small-vessel vasculitis
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