Successful Treatment of Immune Thrombocytopenia as an Extrahepatic Manifestation in an HCV-Carrier Woman with Normal Liver Function Test Results

The authors report a case of immune thrombocytopenia (ITP) as an extrahepatic manifestation in a hepatitis C virus (HCV)-carrier woman with normal liver function tests. The 46-year-old woman visited the Preventive Medical Center of International University of Health and Welfare (IUHW) Hospital in February 2011. She had no complaints and a conventional health check was conducted. The physical and laboratory examinations showed results within normal range except for iron-deficiency anemia and positive for HCV antibody (third generation). HCV-RNA (PCR) was 4.20 Log IU/ml, HCV genotype II and HCV core antibody 484.7. These findings suggested chronic infection with HCV, but there seemed to be no involvement of liver disease. Three months later, at the second visit, she showed thrombocytopenia. We believed the thrombocytopenia to be caused by chronic HCV infection and started anti-HCV viral therapy: interferon α2A (90&mug) injection weekly and ribavirin (600mg/day). Five months later the treatment was discontinued due to neutropenia even though GCSF injections were frequently administered. After treatment for two months, levels of HCV PCR copies were not detected, and the platelet count recovered to normal after six months. Since then three years have passed, HCV-PCR copies have shown non-detectable levels and the platelet count remains normal. There are numerous papers reporting that HCV causes ITP as an extrahepatic manifestation, but a case report of ITP caused by chronic HCV infection without liver disease has not been found. The present case report discusses the specificity of HCV infection on extrahepatic manifestation, and the treatment of ITP caused by chronic HCV infection