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HPB Surgery
Volume 2010, Article ID 841754, 4 pages
http://dx.doi.org/10.1155/2010/841754
Case Report

Hepatectomy for Hepatocellular Carcinoma Complicated by Vasculitis Flare

1New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA
2Department of Rhemutology, New York University School of Medicine, 246 E. 20 St. 1st Floor, New York, NY 10003, USA
3Department of Pathology, New York University School of Medicine, 462 1st Avenue 4W39, New York, NY 10016, USA
4Department of Gastroenterology, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA
5Department of Surgery, New York University School of Medicine, 550 1st Avenue, NBV15S11, New York, NY 10016, USA

Received 9 March 2010; Accepted 8 July 2010

Academic Editor: Christos G. Dervenis

Copyright © 2010 Zeinab Abdi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The hepatitis C virus is a major cause of hepatocellular carcinoma. Extrahepatic manifestations of hepatitis C include mixed cryoglobulinemia which can result in ischemic damage to multiple organs. The management of these sequelae in posthepatectomy patients is unclear. Case Report. A 49-year-old male with hepatitis C was found to have a 4 cm hepatocellular carcinoma on surveillance imaging. He underwent portal vein embolization followed by hepatectomy. His postoperative course was complicated by the development of splenic infarcts, small bowel ischemia, skin lesions, and liver damage. Findings of elevated cryocrit and elevated rheumatoid factor suggested the diagnosis of cryoglobulin-related vasculitis. The patient improved on supportive care. Conclusion. Cryoglobulinemia is associated with hepatitis C and may complicate the care of this patient population. The treatment of cryoglobulinemia posthepatectomy patients is complicated by concerns over how medications may affect the regenerating liver. Steroids should be used with caution in this setting. Summary. Brief report of hepatectomy complicated by vasculitis in the context of hepatocellular carcinoma secondary to hepatitis C addresses the management of mixed cryoglobulinemia in post-hepatectomy patients.