Extrahepatic manifestations are being recognized increasingly in patients with hepatitis C virus (HCV) chronic infection. The objective of this study is to investigate these extrahepatic symptoms as presenting manifestations of HCV chronic infection.We studied 189 patients with HCV chronic infection, demonstrated by the presence of viral RNA in the serum. The presenting symptoms as well as the presence of other extrahepatic manifestations were registered at the first consultation by means of a clinical and laboratory protocol. In 47 patients (24.8%), liver disease was previously undiagnosed and HCV infection manifested itself by extrahepatic symptoms. The mean age was older (p < 0.001), and there were more females (p < 0.001). However, the mean alanine aminotransferase value was lower (p < 0.001) compared with that of the patients who had been seen first for liver disease-related problems. Arthralgias (p < 0.001) and fibromyalgia (p < 0.022) were significantly more common among the patients seen first for extrahepatic manifestations. Other extrahepatic manifestations, such as sicca symptoms, arthritis, and purpura, were also common in these patients. Im-munologic abnormalities were present in 70% of patients.Extrahepatic symptoms were the initial manifestations of HCV chronic infection in 25% of our patients. We point out the importance of extrahepatic manifestations as presenting symptoms of HCV infection.