Abstract
Hepatitis C virus (HCV) is essentially hepatotropic but its manifestations can extend beyond the liver. It can be associated with autoimmune diseases, such as mixed cryoglobulinemia, membranoproliferative glomerulonephritis, autoimmune thyroiditis, and lymphoproliferative disorders. The mechanisms that trigger these manifestations are not completely understood. We describe a 48-year-old man with chronic HCV infection (circulating HCV RNA and moderate hepatitis as indicated by liver biopsy), cryoglobulinemia, and sensory and motor peripheral neuropathy. The diagnosis of multineuropathy was confirmed by clinical examination and electromyographic tests. A nerve biopsy revealed an inflammatory infiltrate in the perineurial space and signs of demyelination and axonal degeneration. The patient had no improvement of neurological symptoms with the use of analgesics and neuro-modulators. He was then treated with interferon-alpha (3 million units subcutaneously, 3 times per week) and ribavirin (500 mg orally, twice a day) for 48 weeks. Six months after the end of therapy, the patient had sustained viral response (negative HCV RNA) and remission of neurological symptoms, but cryoglobulins remained positive. A review of the literature on the pathogenesis and treatment of neurological manifestations associated with HCV infection is presented. This report underscores the need for a thorough evaluation of HCV-infected patients because of the possibility of extrahepatic manifestations. Antiviral treatment with interferon and ribavirin can be effective and should be considered in patients with neurological complications associated with HCV infection.
Highlights
Hepatitis C virus (HCV) infection affects approximately 170 million persons worldwide and is a pandemic 5 times larger than that of HIV
In addition to the liver manifestations, chronic HCV infection may be associated with a series of extrahepatic manifestations, such as mixed cryoglobulinemia, membranoproliferative glomerulonephritis, autoimmune thyroiditis, and lymphoproliferative disorders
We present a patient with chronic HCV infection, cryoglobulinemia, and peripheral neuropathy
Summary
Hepatitis C virus (HCV) infection affects approximately 170 million persons worldwide and is a pandemic 5 times larger than that of HIV. These manifestations result from lymphoproliferative and/or autoimmune mechanisms, and occur in 40 to 75% of patients with chronic HCV infection [2]. The association of HCV infection with mixed cryoglobulinemia and peripheral neuropathy has been previously reported [3]. We present a patient with chronic HCV infection, cryoglobulinemia, and peripheral neuropathy.
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