Progressive Axonal Sensory and Motor Multifocal Polyneuropathy in a Patient with Chronic Hepatitis C


Authors: Z. Ambler 1;  V. Hejda 2
Authors‘ workplace: LF UK a FN Plzeň Neurologická klinika 1;  LF UK a FN Plzeň I. interní klinika 2
Published in: Cesk Slov Neurol N 2011; 74/107(2): 205-208
Category: Case Report

Overview

Five kinds of infectious hepatitis are currently generally recognized, categorised as A, B, C, D and E. From a neurological point of view, the most important is hepatitis C (HCV infection), which is transmitted primarily by blood; its incidence in the Czech Republic has been increasing since 2006. The anicteric and asymptomatic form is common, and many acute HCV infections are not recognized and proceed into the chronic form in up to 80% of cases. Extrahepatic complications of HCV infection occur in as many as 36% of sufferers. Peripheral neuropathies are the most common and may be associated either directly with HCV infection or with a very high degree of association with mixed cryoglobulinemia (cryoglobulinemia with or without vasculitis). Approximately 50–80% of patients with mixed cryoglobulinemia have signs of current HCV infection. Conversely, mixed cryglobulins can be demonstrated in 50% of patients with antibodies against HCV. Involvement of peripheral nerves in cryglobulinemia is about 50–70%. The case report presented concerns a 45-year-old female patient with progressive sensory and motor axonal multifocal polyneuropathy caused by systemic vasculitis in chronic hepatitis C and mixed cryoglobulinemia. Treatment with PEGylated interferon-alpha and ribavirin was associated with a rapid decrease and consequently negative HCV RNA virus in sera according to polymerase chain reaction results but polyneuropathy still progressed. Subsequent treatment with rituximab met with discontinuation of progression.

Key words:
hepatitis C – cryoglobulinemia – peripheral neuropathy


Sources

1. Infekce v ČR – EPIDAT [online]. Dostupné z URL: http://www.szu.cz/publikace/data/infekce-v-cr.

2. Plíšek S, Galský J. Virové hepatitidy. ČLS JEP – Doporučené postupy pro praktické lékaře. Reg. č. o/020/016. Dostupné z URL: http://www.cls.cz/dokumenty2/postupy/r016.rtf.

3. Husa P. Virová hepatitida C. Klin Farmakol Farm 2009; 23: 30–34.

4. Khella SL, Souayah N. Hepatitis C: a review of its neurologic complications. Neurologist 2002; 8(2): 101–106.

5. Sène D, Limal N, Cacoub P. Hepatitis C virus-associated extrahepatic manifestations: a review. Metab Brain Dis 2004; 19(3–4): 357–381.

6. Cacoub P, Saadoun D, Limal N, Léger JM, Maisonobe T. Hepatitis C virus infection and mixed cryoglobulinaemia vasculitis: a review of neurological complications. AIDS 2005; 19 (Suppl 3): S128–S134.

7. Sterling RK, Bralow S. Extrahepatic manifestations of Hepatitis C virus. Curr Gastroenterol Rep 2006; 8(1): 53–59.

8. Primavera A, Cocito L, Reni L, Caponnetto C, Abbruzzese M. Peripheral neuropathies and chronic hepatitis C. J Peripher Nerv Syst 2000; 5: 47–48.

9. Nemni R, Sanvito L, Quattrini A, Santuccio G, Camerlingo M, Canal N. Peripheral neuropathy in hepatitis C virus infection with and without cryoglobulinaemia. J Neurol Neurosurg Psychiatry 2003; 74(9): 1267–1271.

10. Santoro L, Manganelli F, Briani C, Giannini F, Benedetti L, Vitelli E et al. Prevalence and characteristics of peripheral neuropathy in hepatitis C virus population. J Neurol Neurosurg Psychiatry 2006; 77(6): 626–629.

11. Boukhris S, Magy L, Senga-mokono U, Loustaud-ratti V, Vallat JM. Polyneuropathy with demyelinating features in mixed cryoglobulinemia with hepatitis C virus infection. Europ J Neurol 2006; 13(9): 937–941.

12. Moretti R, Torre P, Antonello RM, Cattaruzza T, Pizzolato G. Peripheral neuropathy in hepatitis C virus-related mixed cryoglobulinaemia: existing treatments and a positive symptomatic response to oxcarbazepine. Func Neurol 2006; 21(3): 137–140.

13. Ammendola A, Sampaolo S, Ambrosone L, Ammendola E, Ciccone G, Migliaresi S et al. Peripheral neuropathy in hepatitis-related mixed cryoglobulinemia: Electrophysiologic follow-up study. Muscle Nerve 2005; 31(3): 382–385.

14. Jacobi C, Müller HD, Korporal M, Back T, Wildemann B. Mononeuropathy multiplex as a result of treatment with interferon-α and ribavirin in a patient with hepatitis C. Eur J Neurol 2008; 15(6): e55–e56.

15. Chin RL, Sander HW, Brannagan TH, De Sousa E, Latov N. Demyelinating neuropathy in patients with hepatitis C virus infection. J Clin Neuromuscul Dis 2010; 11(4): 209–212.

16. Boonyapisit K, Katirji B. Severe exacerbation of hepatitis C-associated vasculitic neuropathy following treatment with interferon alpha: A case report and literature review. Muscle Nerve 2002; 25(6): 909–913.

17. Beuthien W, Mellinghoff HU, von Kempis J. Vasculitic complications of interferon-α treatment for chronic hepatitis C virus infection: case report and review of the literature. Clin Rheumatol 2005; 24(5): 507–515.

18. Hirotani M, Nakano H, Ura S, Yoshida K, Niino M, Yabe I et al. Chronic inflammatory demyelinating polyneuropathy after treatment with interferon-alpha. Intern Med 2009; 48(5): 373–375.

19. Kilidireas C, Anagnostopoulos A, Karandreas N, Mouselimi L, Dimopoulos MA. Rituximab therapy in monoclonal IgM-related neuropathies. Leuk Lymphoma 2006; 47(5): 859–864.

Labels
Paediatric neurology Neurosurgery Neurology
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