Chronic hepatitis C virus infection is attributed as a cause of circulating mixed cryoglobulinemia and immune mediated extrahepatic complications. Massive pulmonary haemorrhages with chronic hepatitis C has been scarcely reported; and has been associated with renal failure and cryoglobulinemia. The most commonly used treatment modalities include the use of cyclophosphamide, prednisolone, and plasmapheresis, with conflicting views regarding alternative treatments in resistant cases. Rituximab is an option in resistant cases due to its potent immunosuppressive effects on B cells. We describe a case of hepatitis C-associated mixed cryoglobulinemia and pulmonary hemorrhage resistant to standard treatment. Rituximab led to hepatitis C virus reactivation and fulminant hepatitis.
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Bitar et al. (2014) studied this question.
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