Table 3.
Clinical symptoms, serology, and immunosuppression required before and after direct-acting antiviral therapy
| Pt. | Duration Cryo (years) |
Pretreatment | Regimen | SVR | Post-treatment | ||||
|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Serology | On treatment Immuno- suppression |
Persistent Symptoms |
Serology | Immuno- suppression |
||||
| 1 | 5 | NHBCL, Neuropathy, Reynauds, Arthralgia, GN |
Cryo - 4% C3 - 57 C4 - 2 RF - Positive |
Rituxumab | SOF/SIM | YES | Neuropathy GN |
Cryo - 3 C3 - 148 C4 - 6 RF - Positive |
None |
| 2 | 21 | Neuropathy, Sicca, Reynaud’s, Purpura, GN |
Cryo - 2% C3 - 72 C4 - 16 RF - Positive |
None | SOF/SIM | YES | Reynaud’s, GN |
Cryo - Negative C3 - ND C4 - ND RF - ND |
None |
| 3 | 1 | Purpura, Skin Ulcers, Arthralgias, GN |
Cryo - 1% C3 - 99 C4 - 6 RF - Positive |
None | SOF/RIBA | YES | Arthralgia | Cryo - Trace C3 - 90 C4 - 18 RF - Positive |
None |
| 4 | 10 | GN | Cryo - 3% C3 - 82 C4 - 13 RF - Positive |
None | SOF/SIM | YES | GN | Cryo - 1% C3 - 115 C4 - 16 RF - ND |
None |
| 5 | 5 | Neuropathy, Purpura, GN |
Cryo - 0.5% C3 - 111 C4 - 29 RF ND |
None | SOF/SIM | YES | None | Cryo - Negative C3 - ND C4 - ND RF - ND |
None |
| 6 | 3 | GN | Cryo - 2% C3 - ND C4 - ND RF - Positive |
None | SOF/SIM | YES | None | Cryo - ND C3 - ND C4 - ND RF - ND |
None |
| 7 | 7 | Arthralgia, GN | Cryo - 1% C3 - 51 C4 - 11 RF - Negative |
Ustekinumab (psoriasis) |
SOF/SIM | NO | Arthralgia, GN | Cryo - Negative C3 - 85 C4 - 15 RF - Negative |
Ustekinumab (psoriasis) |
| 8 | 5 | Purpura, Arthralgia | Cryo - 2% C3 - 79 C4 - 2 RF - Positive |
None | SOF/SIM | YES | None | Cryo - ND C3 - ND C4 - ND RF - ND |
None |
| 9 | 0.5 | Neuropathy, Purpura |
Cryo - 0.5% C3 - 66 C4 - 5 RF - Positive |
Rituxumab | SOF/RIBA | YES | Neuropathy | Cryo - ND C3 - ND C4 - ND RF - ND |
Rituximab |
| 10 | 6 | Purpura, Arthralgia, Renal Artery vasculitis |
Cryo - 1% C3 - 89 C4 - 12 RF - Positive |
Rituxumab | SOF/RIBA | NO | Purpura Arthralgia, Renal Artery vasculitis |
Cryo - 2% C3 - 103 C4 - 6 RF - Negative |
Rituximab and Prednisone |
| 11 | 1 | Arthritis | Cryo - 3% C3 - 89 C4 - 27 RF - Positive |
Rituxumab | SOF/RIBA | YES | Arthritis | Cryo - 1% C3 - 110 C4 - 30 RF - Positive |
Rituximab |
| 12 | 1 | Arthritis | Cryo - 1% C3 - 65 C4 - 9 RF - Positive |
None | SOF/SIM | YES | None | Cryo - Negative C3 - 124 C4 - 21 RF - ND |
None |
Legend: Normal range for serum C3 (81–157 mg/dL), C4 (12–39mg/dL). Abbreviations: NHBCL = non-Hodgkin’s B Cell Lymphoma, GN = glomerulonephritis, RF = rheumatoid factor, SOF = Sofosbuvir, SIM = Simeprevir, SVR = sustained virological response