Chronic hepatitis C (hep C) infection can lead to a type of vasculitis called cryoglobulinemia. Complications can be serious and even life threatening, but there are effective treatments.

Hepatitis C is inflammation of the liver caused by the hep C virus (HCV). The bloodborne virus spreads when you come into contact with blood from someone with the virus. Less than half of those who get infected clear it without treatment. More than half go on to develop chronic hep C infection.

Treatment for hep C is highly effective. Direct-acting antiviral agents have a cure rate of about 95%.

But untreated chronic hep C can cause serious liver problems, including cirrhosis, liver failure, and liver cancer. About 75% of people with chronic hep C also have complications outside the liver (extrahepatic). These include type 2 diabetes, skin diseases, and cryoglobulinemia.

Read on to learn more about symptoms, potential complications, and treatment for cryoglobulinemia related to HCV infection.

Cryoglobulinemia is a type of vasculitis. That’s a group of rare disorders having to do with inflammation of the blood vessels.

Cryoglobulins are abnormal proteins in the blood that thicken and clump together when your body temperature falls below 98.6°F (37°C). When you warm up again, the clumps dissolve.

There are three types of cryoglobulinemia:

  • Type 1: involves monoclonal proteins and is usually associated with blood cancers.
  • Type 2 (mixed): has both monoclonal and polyclonal proteins. It’s typically linked to HCV.
  • Type 3 (mixed): includes a mix of polyclonal proteins and is often linked to autoimmune diseases.

It’s hard for blood to flow freely when proteins clump together. Decreased blood flow can cause damage to skin, muscles, and nerves. It can also have a harmful effect on the kidneys and other vital organs, such as the heart, brain, and gastrointestinal tract.

It’s not clear exactly what triggers cryoglobulinemia. According to the National Organization for Rare Disorders, more than 90% of cases of mixed cryoglobulinemia are associated with hep C. But only 30–50% of people with chronic hep C develop it.

Vasculitis is an autoimmune disorder. There are likely several factors that play a role, such as:

  • infections and viruses, including hep C and HIV
  • genetics
  • certain medications
  • autoimmune conditions, including lupus, rheumatoid arthritis (RA), and Sjögren disease
  • environmental factors such as pollution
  • lymphoma

Mixed cryoglobulinemia affects females three times as often as males. It typically occurs between the ages of 40 and 60.

Some people are asymptomatic, even though they have abnormal cryoglobulins in their blood. It’s not clear why, but only about 10–30% of people actually develop symptoms.

The most common signs are:

  • raised red or purple rash (palpable purpura)
  • joint pain and stiffness (arthralgias)
  • nerve damage (peripheral neuropathy)
  • damage to the glomerulus (glomerulonephritis), the part of the kidneys that filters waste from blood

Other symptoms may include:

  • fatigue
  • numbness, tingling, burning sensations, especially in the hands and feet
  • itching
  • discoloration of hands or feet in cold temperatures (Raynaud’s phenomenon)
  • muscle pain and weakness
  • swollen lymph nodes
  • dry mouth
  • abdominal pain
  • hives
  • ulcers
  • loss of tissue (necrosis)
  • kidney damage

Symptoms of brain involvement include:

  • headaches
  • seizures
  • strokes

Symptoms of heart involvement are:

  • chest pain
  • difficulty breathing
  • swelling of the legs

Without treatment, potential complications of mixed cryoglobulinemia include:

  • kidney damage
  • kidney failure
  • increased risk of B-cell non-Hodgkin’s lymphoma

Research suggests that HCV-associated mixed cryoglobulinemia increases morbidity and mortality. Risk factors for a poor outcome include age and kidney involvement.

Early treatment can help ease symptoms, lower the chances of relapse, and prevent long-term complications.

The main treatment is to target the underlying condition, which is hep C. Other options depend on how severe the symptoms are, which organs are involved, and any other co-existing conditions. Your doctor will likely recommend that you avoid cold temperatures and protect your fingers and toes.

Managing cryoglobulinemia with hep C may include:

  • direct-acting antiviral agents alone or in combination with other therapies
  • over-the-counter anti-inflammatory drugs
  • corticosteroids to help control inflammation
  • plasmapheresis, a procedure to clear cryoglobulins
  • rituximab, a drug that helps deplete B cells that produce cryoglobulin

Direct-acting antiviral agents can effectively treat hep C and prevent further complications. But even when treatment works, relapses can occur. That’s why your doctor will likely want to continue monitoring your condition after treatment ends.

Cryoglobulinemia is a type of vasculitis that can affect people with chronic hep C. In this condition, abnormal proteins in the blood clump together when the body falls below normal temperature. This can impair blood flow and cause symptoms such as a raised red or purple rash, joint pain, and fatigue.

Without treatment, it can lead to kidney damage, kidney failure, and other life threatening complications.

Antiviral drugs are the main treatment for cryoglobulinemia related to hep C. These medications are very effective, but some people do relapse. Be sure to keep up with medical checkups and report any new or worsening symptoms.