Reactivation of Chronic Hepatitis C as a Potential Trigger for Guillain-Barré Syndrome

A 74-year-old man with a past medical history of chronic low back pain presented with two to three weeks of progressive weakness starting in the lower extremities and then spreading to the upper extremities. Distal muscles were more affected than proximal muscles; weakness was accompanied by numbness and paresthesias. There was no preceding acute viral, respiratory, or gastrointestinal illness. Initial workup revealed hepatitis C antibody reactivity, and cerebrospinal fluid (CSF) analysis showed albuminocytologic dissociation. MRI demonstrated multilevel degenerative changes and diffuse enhancement of the cauda equina nerve roots compatible with Guillain-Barré syndrome (GBS). Repeat testing confirmed ongoing hepatitis C infection with increasing quantitative hepatitis C virus (HCV) levels. This case illustrates an interesting presentation of GBS potentially triggered by hepatitis C reactivation. This is the first case, to our knowledge, with serologic evidence demonstrating acute hepatitis C reactivation concurrent with GBS which presented in the absence of immunomodulatory interferon treatment. The patient continues to recover with ongoing rehabilitation at the time of this case report.