jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2020-12-1-104-110jofin-1020Research ArticleКлинический случайClinical CaseЭрадикация вируса гепатита с у пациентки с криоглобулинемическим васкулитом и наличием мутаций D168E, L31VEradication of hepatitits C virus in patient with cryoglobulinemic vasculitis and mutations D168E, L31VДунаеваН. В.DunaevaN. V.

Дунаева Наталья Викторовна – заведующая отделением соматической патологии, к.м.н., доцент.

Санкт-Петербург, тел.: +7-921-741-88-20

Saint-Petersburg

nvch@mail.ruЧирскаяМ. А.ChirskayaM. A.

Чирская Мария Александровна – врач-дерматовенеролог отделения соматической патологии.

Санкт-Петербург,  тел.: +7-981-740-03-53

Saint-Petersburg

КолпащиковаЕ. Ю.KolpashchikovaE. Yu.

Колпащикова Елена Юрьевна – врач-инфекционист отделения хронических гепатитов.

Санкт-Петербург, тел.: +7-906-251-09-63

Saint-Petersburg

polet_orla@mail.ruРомановаС. Ю.RomanovaS. Yu.

Романова Светлана Юрьевна – заведующая отделением хронических гепатитов.

Санкт-Петербург, тел.: +7-921-919-82-57

Saint-Petersburg

romanova_su@mail.ruЛапинС. В.LapinS. V.

Лапин Сергей Владимирович – заведующий лабораторией диагностики аутоиммунных заболеваний,  к.м.н.

Санкт-Петербург, тел.: 8(812)994-53-24

Saint-Petersburg

autoimmun@mail.ruКаревВ. Е.KarevV. E.

Saint-Petersburg

vadimkarev@yandex.ruГусевД. А.GusevD. A.

Гусев Денис Александрович – главный врач, д.м.н., профессор.

Санкт-Петербург, тел.: 8(812)251-08-53

Saint-Petersburg

gusevden-70@mail.ruЦентр по борьбе со СПИД и инфекционными заболеваниямиРоссияCenters for AIDS and Other Infectious DiseasesRussian FederationПервый Санкт-Петербургский государственный медицинский университет им. академика И.П. ПавловаРоссияFirst Saint-Petersburg State Medical University named after academician I.P. PavlovRussian FederationДетский научно-клинический центр инфекционных болезнейРоссияPediatric Research and Clinical Center for Infectious DiseasesRussian Federation202020032020121104110Copyright © Дунаева Н.В., Чирская М.А., Колпащикова Е.Ю., Романова С.Ю., Лапин С.В., Карев В.Е., Гусев Д.А., 20202020Дунаева Н.В., Чирская М.А., Колпащикова Е.Ю., Романова С.Ю., Лапин С.В., Карев В.Е., Гусев Д.А.Dunaeva N.V., Chirskaya M.A., Kolpashchikova E.Y., Romanova S.Y., Lapin S.V., Karev V.E., Gusev D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/1020

В статье демонстрируется случай хронического гепатита С 1b генотипа с фиброзом 3 степени по Metavir, осложнённый развитием  смешанной криоглобулинемии III типа, криоглобулинемическим васкулитом с поражением сосудов кожи  (геморрагический васкулит), печени (альтеративно-пролиферативный  васкулит).  Назначение  режима  даклатасвир  +  асунапревир  оказалось вирусологически  неудачным:  на  фоне  вирусологического прорыва были  выявлены мутации D168E и L31V. Повторный  курс противовирусной терапии  комбинацией Гразопревир+Элбасвир  в  сочетании  с  софосбувиром привел  к  достижению  устойчивого  вирусологического ответа,  частичным  иммунологической  и  клинической ремиссиям.

The case of chronic hepatitis C 1b genotype with grade 3 fibrosis according to Metavir, complicated by the development  of mixed  type  III  cryoglobulinemia,  cryoglobulinemic vasculitis with damage to the skin vessels of the skin (hemorrhagic vasculitis), and the liver (alternatively proliferative vasculitis) is demonstrated. The introduction of daclatasvir + asunaprevir was virologically unsuccessful: mutations D168E and L31V were detected against  the background of a  virological breakthrough. A repeated course of antiviral therapy with the combination of Grazoprevir + Elbasvir in combination with sofosbuvir led to a stable virologic response, partial immunological and clinical remission.

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The authors declare that there are no conflicts of interest present.