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Extrahepatic manifestations of hepatitis C
  1. Sanjay Gupta1,
  2. Nadeem Tehami1,
  3. Anne Tarn2
  1. 1Department of Gastroenterology, Croydon University Hospital, Croydon, UK
  2. 2Department of Clinical Pathology, Croydon University Hospital, Croydon, UK
  1. Correspondence to Dr Sanjay Gupta, Department of Gastroenterology, Croydon University Hospital, 530 London Road Croydon Surrey, Croydon, Surrey CR7 7YE, UK; san1gupta{at}hotmail.com

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We read with interest the article on extrahepatic manifestations of hepatitis C virus by Samuel and Rees.1 We report a dermatological manifestation of hepatitis C, which the authors have not mentioned.

A 38-year-old man with hepatitis C was admitted with upper gastrointestinal bleed. He was found to have oesophageal varices that were banded. He developed a tender purpuric rash with ulceration on his lower limbs. There were no other associated symptoms. A clinical diagnosis of cryoglobulinaemia was considered. Vasculitic screen was negative.

Samples were tested for the presence of cryoglobulins using standard laboratory procedures comparing plasma and serum samples kept at 37°C, with those then cooled and incubated at 4°C to demonstrate cryoprecipitation. Initial examination showed no visible …

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