<prompt> Extrahepatic manifestations of hepatitis include the following except -Serum sicknessGlomerulonephritisGeneralized vasculitisPalmo-plantar keratosis  <response>: Ans. is d i.e., Palmo-plantar keratosis Extrahepatic manifestations of viral hepatitis Immune complex-mediated tissue damage appears to play a pathogenetic role in the extrahepatic manifestations of acute hepatitis B. The occasional prodromal serum sickness-like syndrome observed in acute hepatitis B appears to be related to the deposition in tissue blood vessel walls of HBsAg-anti-HBs circulating immune complexes, leading to activation of the complement system and depressed serum complement levels. In patients with chronic hepatitis B, other types of immune- complex disease may be seen. Glomerulonephritis with the nephrotic syndrome is observed occasionally; HBsAg, immunoglobulin, and C3 deposition has been found in the glomerular basement membrane. While generalized vasculitis polyarteritis nodosa develops in considerably fewer than 1 of patients with chronic HBV infection, 20-30 of patients with polyarteritisnodosa have HBsAg in serum. Another extrahepatic manifestation of viral hepatitis is essential mixed cryoglobulinemia EMC. The disorder is characterized clinically by arthritis; cutaneous vasculitis palpable purpura; and, occasionally, with glomerulonephritis and serologically by the presence of circulating cryoprecipitable immune complexes of more than one immunoglobulin class. Many patients with this syndrome have chronic liver disease and a substantial proportion has chronic HCV infection, with circulating immune complexes containing HCV RNA. Immune-complex glomerulonephritis is another recognized extrahepatic manifestation of chronic hepatitis C. 