Peripheral neuropathy associated with essential mixed cryoglobulinaemia: a role for hepatitis C virus infection?

Abstract

Background-The prevalence of hepatitis C virus (HCV) infection has been estimated at 43 to 84% in patients with essential mixed cryoglobulinaemia in recent large series. Some of these cases have been successfully treated with interferona. The objective was to evaluate the prevalence and the possible role of HCV infection in essential mixed cryoglobulinaemia. Methods-Fifteen patients (eight men and seven women; mean age: 612 (SD 16.5) years) with peripheral neuropathy (10 polyneuropathies and five multifocal mononeuropathies) and essential mixed cryoglobulinaemia were tested for serum anti-HCV antibodies. Results-Antibodies were found in 10 of 15 patients involving either polyneuropathies (seven patients) or multifocal mononeuropathies (three patients). Electrophysiological studies and teased nerve fibre studies (in seven patients) allowed neuropathies to be classified as predominantly sensory axonopathies. Compared with HCV-negative (HCV -) patients, HCV-positive (HCV +) patients had a more pronounced and more widespread motor deficit; motor nerve conduction velocities in peroneal and median nerves were more impaired in HCV + patients, although significance was not reached except for the mean value of the amplitude of the compound muscle action potentials of the median nerves (P < 0-05); necrotising vasculitis was found in two of nine nerve biopsies from the HCV + patients studied and in none of the three HCV -patients. In addition, HCV + patients had more frequent cryoglobulin related cutaneous signs, higher aminotransferase and serum cryoglobulin concentrations, lower total haemolytic complement concentrations, and more frequent presence of rheumatoid factor. A liver biopsy performed in eight HCV + patients disclosed a range of lesions, from chronic active hepatitis (six patients) to persistent hepatitis (two patients). Lastly, treatment with interferon-a conducted over six months in two patients seemed to improve the peripheral neuropathy. Conclusions-Patients with peripheral neuropathy and essential mixed cryoglobulinaemia should be tested for anti-HCV antibodies to determine the appropriate treatment.

Peripheral neuropathy in patients with hepatitis virus C infection in the Amazon region

“…A p roximadamente 34% dos pacientes se queixaram de parestesias, principalmente nos membros superiores. A ENMG diagnosticou mononeuropatia múltipla em 11 (14,1%, IC95% 7,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)2) pacientes e síndro m e do túnel do carpo em 4 (5,1%). Conclusão: C o m p rometimento dos nervos periféricos é comum em pacientes com VHC, sendo neuropatia múltipla a apresentação mais comumente diagnosticada pela ENMG.…”

Alterações neurológicas em pacientes submetidos a transplante hepático: análise de 30 casos consecutivos

“…Por outro lado, um caso de mononeuropatia múltipla, prévia ao TxH, afetando principalmente o membro inferior direito distalmente, atribuída à infecção pelo vírus C associada a crioglobulinemia, mostrou-se inalterado. Estes quadros são pouco referidos na literatura [4][5][6] . Na segunda semana, o caso em que ocorreu diminuição do nível de consciência foi relacionado a alterações metabólicas e hidro-eletrolíticas do diabete mélito (DM) e a agudização do quadro foi relacionada ao uso de cortisona, fundamentalmente.…”

“…A cefaléia é uma queixa frequente que pode estar presente desde os primeiros momentos do pós-operatório, sendo, mais comumente, associada ao uso de drogas 2,3,[6][7][8]10,12 . Neuropatias e miopatias também podem se manifestar agudamente após o transplante [2][3][4][5][6][7]12,17 .…”

Mixed Cryoglobulinemia Associated with Hepatitis C Virus Infection

“…This axonal degeneration is thought to be due to ischemia following endoneural microangiopathy and vasculitis of epineural arteries (15). In MCpatients with HCVinfection, polyneuropathies or multifocal mononeuropathiescaused by sensory axonopathies were observed as the same as essential MC (16). However, compared with MCpatients without anti-HCVantibodies, neuropathies were more severe, because of motor involvement, and in addition, vasculitis and alterations of endoneural microvessels were more frequently observed (16).…”

“…In MCpatients with HCVinfection, polyneuropathies or multifocal mononeuropathiescaused by sensory axonopathies were observed as the same as essential MC (16). However, compared with MCpatients without anti-HCVantibodies, neuropathies were more severe, because of motor involvement, and in addition, vasculitis and alterations of endoneural microvessels were more frequently observed (16). On the other hand, a rare case of cryoglobulinemic neuropathy, presenting myelinopathy, with HCVinfection was reported in this journal (17).…”