manifestations of chronic hepatitis C Neurological .

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manifestations of chronic hepatitis CNeurological .Heckmann JG, Kayser C, Heuss D, Manger B, Blum HE, Neundorfer B.Department of Neurology, University of Erlangen-Nuremberg, Erlangen,Germany.Hepatitis C virus (HCV) infection is often associated with abnormalimmunological responses. We describe four patients with vasculiticneurological signs and symptoms following HCV infection. A 56-year-oldwoman with HCV infection developed peripheral neuropathy characterizedby asymmetric distal painful hypesthesia, dysesthesia and moderate motorweakness of the lower limbs. Serological examinations revealedcryoglobulinemia and low levels of complement C4. A biopsy of the suralnerve revealed vasculitic neuropathy. HCV infection associatedimmunomediated vasculitis was diagnosed. While steroid therapy wasineffective, treatment with interferon-alpha improved the neuropathyconsiderably without, however, eliminating HCV infection. A 62-year-oldman with HCV infection developed peripheral sensory neuropathy.Complement C3 was slightly diminished. Nerve biopsy revealed vasculiticneuropathy. A 71-year-old woman developed chronic symmetric sensomotorpolyneuropathy. HCV hepatitis followed blood transfusions. Cryoglobulinstested positive, consistent with type II cryoglobulinemia. ComplementsC3 and C4 were diminished. Inflammatory infiltrates in the sural nervebiopsy specimen led to the diagnosis of chronic vasculitic disorder. A55-year-old woman with HCV infection developed vasculitis of the skin,connective tissue, visceral organs, and kidney, leading to hemodialysis.Neurologically she developed severe apathy and drowsiness, myoclonicjerks, exaggerated deep tendon reflexes, and positive pyramidal signs.Magnetic resonance imaging of the brain showed diffuse increased signalabnormalities involving supra- and infratentorial white mattersuggesting cerebral vasculitis. Cryoglobulins were positive, complementsC3 and C4 slightly diminished (54 mg/dl, 4.3 mg/dl). Supportive therapyresulted in neurological improvement. Treatment with interferon-alphawas discontinued because of agranulocytosis. In patients with peripheralneuropathy or signs of leucencephalopathy, a hepatitis C associatedvasculitis should be considered in the differential diagnosis.PMID: 10431776 [PubMed - indexed for MEDLINE]

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