LETTER
Testing with Antineutrophil Cytoplasmic Antibody To Diagnose Wegener Granulomatosis
Stephen D.H. Malnick, MA, MSc, MBBS;
Ella Evron, MD; and
Zev M. Sthoeger, MD
1 October 1996 | Volume 125 Issue 7 | Page 622
TO THE EDITOR:
The recent paper by Rao and colleagues [1] was most interesting. We wish to explain the low positive predictive value of 63% for a positive c-ANCA test that the authors noted.
Approximately 2% of the world's population is estimated to have chronic hepatitis C virus (HCV) infection [2]. It is now apparent that several extrahepatic manifestations are linked to chronic HCV disease [3]. These include vasculitis and cryoglobulinemia, which may cause symptoms similar to those of Wegener granulomatosis. We recently found a high (43.8%) incidence of c-ANCA in a cohort of patients with chronic HCV disease [4] who were referred consecutively to the liver clinic at our hospital. If our findings are applicable to the world population of patients with HCV infection, more than 100 million persons may have c-ANCA antibodies in association with chronic HCV infection. Thus, one may encounter patients with a suspicious clinical picture and c-ANCA antibodies possibly linked to HCV rather than to Wegener granulomatosis.
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Author and Article Information
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Kaplan Hospital, Rehovot 76100, Israel
1. Rao JK, Weinberger M, Oddone EZ, Allen NB, Landsman P, Feussner JR. The role of antineutrophil cytoplasmic antibody (c-ANCA) testing in the diagnosis of Wegener granulomatosis. A literature review and meta-analysis. Ann Intern Med. 1995; 123:925-32.
2. Davis GL. Hepatitis C virus. In: Mandell GL, Douglas RG, Bennet JE, eds. Principles and Practice of Infectious Diseases: Update 10. New York: Churchill Livingstone; 1991:3-11.
3. Gumber SC, Chopra S. Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations. Ann Intern Med. 1995; 123:615-20.
4. Malnick SD, Lurie Y, Fogel N, Cohen P, Geltner D, Bass DD, et al. Chronic HCV hepatitis is associated with a high incidence of anti-neutrophil cytoplasmic antibodies and anti-cardiolipin antibodies [Abstract]. Hepatology. 1995; 22:352A.
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