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Motor-axonal polyneuropathy associated with hepatitis C virus
J Costa1, C Resende, M de Carvalho
1Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal.
Insights
Hepatitis C virus (HCV) infection is linked to nerve damage. This study identifies a new association between HCV and pure motor-axonal polyneuropathy, even without cryoglobulinemia.
Area of Science:
- Neurology
- Infectious Diseases
- Hepatology
Background:
- Hepatitis C virus (HCV) infection is a known cause of mixed cryoglobulinemia and peripheral neuropathy.
- Peripheral polyneuropathy has been associated with chronic HCV infection, often presenting as sensory axonopathies.
- Cryoglobulinemia, particularly essential mixed cryoglobulinemia (type II), is frequently observed in HCV patients.
Observation:
- Previous research documented sensory axonopathies or vasculitis with HCV-related neuropathy, especially when cryoglobulinemia is present.
- The association between HCV and peripheral neuropathy without cryoglobulinemia has been noted.
- This study observed a unique case of pure motor-axonal polyneuropathy in an HCV-infected patient without cryoglobulinemia.
Findings:
- This is the first reported case of pure motor-axonal polyneuropathy associated with Hepatitis C virus infection in the absence of cryoglobulinemia.
- The findings expand the spectrum of neurological manifestations linked to HCV.
- This case highlights the need to consider HCV in patients with unexplained motor-axonal polyneuropathy, irrespective of cryoglobulinemia status.
Implications:
- Clinicians should consider HCV testing in patients presenting with pure motor-axonal polyneuropathy, even without evidence of cryoglobulinemia.
- This discovery may lead to earlier diagnosis and treatment of HCV-related neurological complications.
- Further research is warranted to understand the pathogenesis of HCV-associated motor-axonal polyneuropathy.
Abstract:
The association between hepatitis C virus (HCV) infection, the presence of mixed cryoglobulinemia and peripheral neuropathy is well-documented (Apartis et al., 1996). HCV is the chief cause of essential mixed cryoglobulinemia (type II cryoglobulinemia) with cryoglobulins present in up to half of patients with HCV infection (Akriviadis et al., 1997). More recently it has been stated that peripheral polyneuropathy may be associated with HCV chronic infection without mixed cryoglobulinemia (Lidove et al., 2001). Patients usually present with a clinical and electrophysiology--predominantly sensory axonopathies (Apartis et al., 1996; Heckmann et al., 1999) or less frequently with fulminating vasculitis and mononeuropathy multiplex syndrome (David et al., 1996)--especially when associated with cryoglobulinemia. We report, for the first time, the association between pure motor-axonal polyneuropathy and HCV infection without cryoglobulinemia.