Fibrosierende alveolitis bei hepatitis-C-assoziierter kryoglobulinämie

History and admission findings: A 56-year-old man presented with fever, myalgia and weakness of the limbs for four weeks. Physical The examination showed a skin rash, hepatomegaly and reduced mobility of the, limbs due to pain. Investigation: Laboratory tests revealed an elevated rheumatoid factor, cryoglobulins and were positive for hepatitis C-antibodies . The lung function tests indicated mild obstruction and a moderate decrease of diffusion capacity. Bronchoalveolar lavage showed lymphocytic alveolitis. Computed tomography of the thorax revealed mediastinal lymphadenopathy, diffuse groundglass infiltrates and bilateral signs of fibrosis in the lower lung fields. Diagnosis, treatment and course: Because of the fibrosing alveolitis associated with hepatitis C-related cryoglobulinemia immunosuppression was started with high-dosage prednisone and azathioprine. The symptoms improved on this treatment. Conclusion: Hepatitis C-related cryoglobulinemia is a rare condition that usually presents with nonspecific symptoms. Severe pulmonary involvement is very uncommon. There are no general guidelines about treatment.