ACUTE SENSORY NEURONOPATHY ASSOCIATED WITH HEPATITIS C INFECTION

Abstract

A 52-year-old African American woman was admitted to the hospital for evaluation of 2 weeks of abdominal pain, nausea and vomiting. She also complained of numbness and tingling of the extremities and urinary incontinence. Physical examination was remarkable for abdominal distension, sluggish bowel sounds, nystagmus and signs of peripheral sensory loss. Comorbid conditions included diabetes, hypertension and stable seizure disorder. CT scan of chest, abdomen and pelvis showed diffuse fatty liver and partial small bowel obstruction. CT scan and MRI of the brain and MRI of the spine were normal. Labs: WBC = 6700K/UL, Na = 133MEQ/L, K = 3.1MEQ/L, Glu = 121MG/DL, ALP = 92U/L, AST = 57U/L, ALT = 16U/L, Albumin = 3.2GM/DL, Total Protein = 9.2MG/DL, ESR =118. Lumbar puncture was negative. Urine toxicology, Rheumatology panel including ANA, Rheumatoid factor, Scleroderma and Sjogrens antibodies and ANCAs, serologies for HTLV1, HTLV2, HIV and Syphilis were negative. Hepatitis C antibody was positive and Hepatitis C RNA viral count was 2660 copies. Hospital Course: While the intestinal obstruction gradually improved, her neurologic condition stayed the same for several days. Nerve conduction velocity and electromyographic studies were done which showed severe sensory neuronopathy with intact motor conduction. EMG was normal. She was given a trial of intravenous immune-globulins with no immediate effect; however, her condition began to show some improvement 5 days later. Patient was started on physical therapy and subsequently discharged to a rehabilitation center. Discussion: Sensory neurono pathy occurs when sensory ganglion cells, or neurons, are affected by a pathologic process. This is different from sensory neuro pathy in which the primary destruction happens in peripheral nerves. There have been reports of acute sensory neuronopathy related to para-neoplastic syndromes, especially with small cell carcinoma of lung, and connective tissue disorders, particularly Sjogrens syndrome. Infection with HTLV1 is the most common infectious disease reported in relation with this condition. In our case, an extensive work up did not reveal any specific reason for neuronopathy besides Hepatitis C infection. Pathogenesis of this condition may be related to an immune reaction against antigens shared by both the neurons and hepatits C viruses.