1. Manifestations of Chronic Hepatitis C Virus Infection Beyond the Liver
Ira M. Jacobson, Patrice Cacoub, Luigino Dal Maso, Stephen A. Harrison, Zobair M. Younossi 
Clinical Gastroenterology and Hepatology 
Volume 8, Issue 12, Pages (December 2010)
DOI: /j.cgh
Copyright © 2010 AGA Institute Terms and Conditions

2. Figure 1
Possible mechanisms of mixed cryoglobulinemia vasculitis. HCV-mediated effects on lymphocytes may lead to antibody production and formation/deposition of immune complexes containing rheumatoid factor, resulting in tissue damage. IgG, immunoglobulin G.
Clinical Gastroenterology and Hepatology 2010 8, DOI: ( /j.cgh )
Copyright © 2010 AGA Institute Terms and Conditions

3. Figure 2
Differential diagnosis between mixed cryoglobulinemia and other autoimmune-lymphoproliferative disorders in the setting of HCV infection. MC syndrome, primary SS, and RA show a clinicopathological overlap, including the possible association with HCV infection. Adapted with permission (Ferri C, Mascia MT. Cryoglobulinemic vasculitis. Curr Opin Rheumatol 2006;18:54–63). The following parameters may be usefully employed for a correct differential classification/diagnosis: primary SS shows typical histopathological pattern of salivary gland involvement and specific autoantibodies (anti-RoSSA/LaSSB), which are rarely found in MC patients; conversely, cutaneous leukocytoclastic vasculitis, visceral organ involvement (glomerulonephritis, hepatitis), low C4, and HCV infection are typically found in MC. Moreover, erosive symmetrical polyarthritis and serum anti-CCP characterize classical RA. Finally, B-NHL may complicate these diseases, more frequently MC and SS. The appearance of B-NHL can be detected by timely and careful clinicoserological monitoring and diagnosed by bone marrow/lymph node biopsies and total body CT scan. Anti-CCP, anti-cyclic citrullinated peptide antibodies; B-NHL, B-cell NHL; RF, rheumatoid factor; SS, Sjögren's syndrome.
Clinical Gastroenterology and Hepatology 2010 8, DOI: ( /j.cgh )
Copyright © 2010 AGA Institute Terms and Conditions

4. Figure 3
Possible mechanisms of lymphoma development include growth stimulation via BLys ligand-receptor activity, progression from MC to lymphoma via an oncogenic event, and direct and indirect lymphocyte transformation. AID, activation-induced deaminase; BCR, B cell receptor; NOS, nitric oxide synthase.
Clinical Gastroenterology and Hepatology 2010 8, DOI: ( /j.cgh )
Copyright © 2010 AGA Institute Terms and Conditions

5. Figure 4
Possible mechanisms of insulin resistance include effects of HCV-induced fibrosis/cirrhosis, direct viral effects on insulin sensitivity via proinflammatory cytokines, and effects of obesity in the development of insulin signalling defects.
Clinical Gastroenterology and Hepatology 2010 8, DOI: ( /j.cgh )
Copyright © 2010 AGA Institute Terms and Conditions