Hepatitis C Virus and Porphyria Cutanea Tarda: Evidence of A Strong Association

Abstract

Porphyria cutanea tarda in human beings is believed to be due to reduced hepatic uroporphyrinogen decarboxylase activity. However, extrinsic factors such as alcohol abuse and drug intake are required for clinical manifestation of the disease. In addition to typical cutaneous lesions, patients with porphyria cutanea tarda usually have chronic liver disease and moderate iron overload. Of 74 Italian patients with porphyria cutanea tarda, hepatitis C virus antibodies were detected in 76% by enzyme-linked immunoassay and in 82% by recombinant immunoblot assay. Viral genome, studied with nested polymerase chain reaction, was found in the sera of 49 subjects--47 positive and 2 indeterminate on recombinant immunoblot assay. Five percent of the patients were HBsAg-positive, and about 40% had had past hepatitis B contacts. Alcohol abuse was present in 38%. Liver biopsies performed in 42 patients showed chronic persistent hepatitis in 7 patients, chronic active hepatitis in 22 patients, fibrosis in three patients and cirrhosis in 10 patients. Hepatitis C virus antibody was detected in 100% of patients with chronic active hepatitis and in about 80% of all other groups. Alcohol abuse was more frequent in patients with cirrhosis (80%) than in the other groups. In Italian patients with porphyria cutanea tarda, the prevalence of hepatitis C virus infection was very high, comparable to that in non-A, non-B hepatitis and high-risk patient groups. Hepatitis C virus is probably the main pathogenetic factor of the liver disease of patients with porphyria cutanea tarda.

Porfiria cutânea tardia

“…60 Viral infections -The role of hepatotropic viruses in triggering PCT has been reported since 1992. 61 the prevalence of anti-HCV antibodies ranges from 8% to 90%, and it is related to its endemicity in the population, 9,11,62 being higher in some regions of Europe (France, 63 Spain, 64 Italy 31,61 e Poland 65 ) and in the United States. 53 There is no predominance of HCV genotype in porphyrias.…”

Functional B-cell response in intrahepatic lymphoid follicles in chronic hepatitis C

“…3 HCV is known to cause a variety of systemic immunologic reactions or abnormalities such as circulating immune complexes, 4 autoantibodies, 5,6 and autoimmune manifestations. [7][8][9][10] Although the liver is considered the primary site of HCV replication with convincing evidence, 11,12 systemic or extrahepetic immune reactions, as well as intrahepatic responses, can be induced in the course of chronic infection.…”

Hepatitis C as another possible cause of porphyria cutanea tarda and systemic lupus erythematosus: Comment on the article by Kutz and Bridges

“…In their interesting case report, Rubin et al describe a pregnant systemic lupus erythematosus (SLE) patient who developed pulmonary vasculitis leading to death in the early postpartum period (1). Although the authors stated that this was an unreported complication of pregnancy in SLE, we have reported an almost identical case (2). Both our patient and the patient described by Rubin and coworkers became acutely dyspneic and died within 24 hours following vascular collapse and progressive hypoxemia.…”

“…It has been recommended that all patients presenting with PCT be screened for hepatitis C infection (7)(8)(9)(10). In addition, there has been evidence presented (1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14] which shows that hepatitis C viral infection can induce high-titer antinuclear antibodies, other autoantibodies including anti-DNA in low titer, and clinical immunologic disorders which in combination may cause a patient to meet the American College of Rheumatology (ACR) 1982 criteria for SLE (15).…”