Hepatitis C Infection and Paroxysmal Nocturnal Hemoglobinuria with Complicated Course: Coincidental Association or True Link?

Hepatitis C virus (HCV) infection is a major health problem worldwide. It is a well-documented systemic disease whose extra hepatic consequences increase the weight of its pathological burden. Paroxysmal nocturnal hemoglobinuria (PNH) is a rare but life-threatening bone marrow failure disorder that manifests with hemolytic anemia, thrombosis and peripheral blood cytopenia. Fortunately, the introduction of Eculizumab, a humanized monoclonal antibody, has brought a paradigm shift in PNH management and prognosis. We hereby report an unusual association of HCV and PNH which has witnessed persistent breakthrough hemolysis and progression to complications despite Eculizumab. Our report suggests reconsidering the management of PNH patients with HCV especially since the only approved PNH treatment (Eculizumab) is one of the world’s most expensive drugs and must be administered indefinitely for a sustained response [1].