Their hypothesis was finally proved about two decades later, but with an added twist, when it was discovered that there was indeed a breach of immune defenses. Hepatitis C virus (HCV) was discovered to be concentrated 1,000-fold in the cryoglobulin protein of affected individuals.5 Tearing a page out of a spy thriller, it turned out that a particular cryoglobulin idiotype could bind to very low-density lipid (VLDL)–like particles that masked HCV, allowing it to avoid detection when entering the liver cell attached to its LDL receptor.5
Nowadays, we consider EMC in a different light, as upward of 90% of patients are positive for HCV. More critical than renaming EMC as HCV-associated type II cryoglobulinemia has been the subsequent transformation of our treatment of this disease from requiring high doses of corticosteroids along with the frequent addition of cytotoxic drugs to a multisystem infectious illness requiring antiviral therapy targeting HCV.
Might there be other similar situations where we are mistakenly treating viral infections as autoimmune conditions? Lately, the neurology literature has been replete with clinical observations suggesting a link between the development of strokes following exposure to varicella zoster virus (VZV).6 This virus has been implicated in some cases of aortitis, and its role has also been questioned in the pathogenesis of giant cell arteritis.7 Beneath the painful, itchy dermatomes, might VZV be wreaking even more havoc deep inside by promoting damaging inflammatory responses within our vasculature?
Given the nanoscale size of viruses & their infectious snippets of DNA & RNA, it should come as no surprise to learn that the number of free virions just residing at body barrier sites, such as the gut, oropharynx and skin, may range as high as 109 particles per gram. Step aside, microbiome: It has been estimated that the human body may contain an eye-popping 1015 bacteriophages that regulate the structure & function of bacterial communities through their lytic & lysogenic cycles.
Blurred Lines
Indeed, the lines separating infection and immunity can get quite blurred. Consider the case of Kawasaki’s disease (KD), an uncommon pediatric disorder that was first recognized in Japan in the 1960s by a Japanese pediatrician, Tomisaku Kawasaki, MD. He and others described young children, often boys, presenting with fever, cutaneous lesions and swollen appendages.8 Beneath this outward visage of an infectious illness, though one without a defined cause, lay a rare but potentially lethal complication, the formation of coronary aneurysms in the young child’s heart.
