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