Autoimmune hemolytic anemia in treatment-naive chronic hepatitis C infection

Extrahepatic immunologic abnormalities have been shown to occur in patients with chronic hepatitis C virus (HCV) infection. Induction of autoimmune hemolytic anemia has been reported, either during or after interferon treatment of HCV infection. I report a 48-year-old patient with HCV infection who developed Coombs-positive autoimmune hemolytic anemia in the absence of treatment with interferon, with a review of the available literature. Other potential etiologies of autoimmune hemolytic anemia were ruled out. Prednisone therapy was instituted because of the severity of the fall in the hemoglobin. There was resolution of the hemolytic anemia and the prednisone was tapered gradually. No deterioration of the underlying HCV liver disease was evident even though an increase in HCV viremia was noted. Coombs-positive autoimmune hemolytic anemia can occur as an extrahepatic immunologic abnormality in treatment-naive patients with chronic HCV infection.