Answer 3 Mixed cryoglobulinemia. A link between HCV infection and mixed cryoglobulinemia exists. This patient has a rash consistent with a leukocytoclastic vasculitis caused by cutaneous deposition of cryoimmunoglobulins. There is also deposition of immune complexes in small- and medium-sized vessels as evidenced by the gastrointestinal and renal involvement. Treatment consists of corticosteroids and cytotoxic agents. Henoch-Schönlein purpura typically is preceded by an upper respiratory infection. Polyarteritis nodosa generally has painful ulcerating lesions on the lower extremities and is associated with hepatitis B virus (HBV) infection rather than HCV infection. Porphyria cutanea tarda is a disorder of heme biosynthesis that manifests as a bullous rash on sun-exposed skin. Cellulitis is unlikely given that the lesions are not warm and tender. Click here to return to the questions

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