Transverse myelitis associated with chronic viral hepatitis C.
ABSTRACT HCV infection could cause several extra hepatic diseases including mixed cryoglobulinemia. Peripheral neuropathy is the most common complication of mixed cryoglobulinemia. In addition to cryoglobulinemia's neuropathy, transverse myelitis had been related to HCV infection.
But causality of this association is not clearly established.
A 55-year-old man presented with motor deficiency in lower extremities and urinary retention. Neurological exams showed a spastic paraparesis and proprioceptive ataxia. Spinal MRI revealed a contrast enhancing signal abnormality within the spinal cord extending from Levels C3 to C5. Serology hepatitis C and viremia were positive. Clinical diagnosis of acute demyelinating sensorimotor polyneuropathy associated to chronic hepatitis C was etablished.
Screening of HCV infection must be done in patients with transverse myelitis and no clear aetiology.
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ABSTRACT: Virus-induced spinal cord damage results from a cytolytic effect on anterior horn cells or from predominantly cellular immune-mediated damage of long white matter tracts. Infection with the hepatitis virus group, most notably hepatitis C virus, has infrequently been associated with the occurrence of myelitis. The pathogenesis of hepatitis virus-associated myelitis has not been clarified: virus-induced autoimmunity (humoral or cell-mediated, possibly vasculitic) seems the most likely disease mechanism. Limited available information offers no evidence of direct hepatitis virus infection of the spinal cord. Virus neuropenetration may occur after virus-infected mononuclear cells penetrate the blood-brain barrier, but a true neurolytic effect has not been demonstrated. Attacks of acute myelitis usually respond favorably to immunomodulatory therapy. Antiviral therapy plays no confirmed role in the treatment of acute bouts of myelitis, but may limit the relapsing course of HCV-associated myelitis.Journal of neuroimmunology 09/2011; 239(1-2):21-7. DOI:10.1016/j.jneuroim.2011.09.001 · 2.79 Impact Factor
Article: Infectious Myelitis.[Show abstract] [Hide abstract]
ABSTRACT: Infections are an uncommon but very important etiology of myelitis as a correct diagnosis would allow for timely treatment and recovery. The term "myelitis" is generally used to describe an inflammatory pathologic process affecting the spinal cord and causing an interruption of the ascending and descending pathways, and, therefore, partial or complete loss of function. The onset may be acute or subacute, and the etiology may be cumbersome to determine. This article will review the most recently published literature regarding the infectious agents causing myelitis with an emphasis on diagnosis and treatment.Current Neurology and Neuroscience Reports 08/2012; 12(6). DOI:10.1007/s11910-012-0306-3 · 3.67 Impact Factor
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ABSTRACT: We report a case of acute myelitis associated with hepatitis C virus (HCV) infection. A Japanese woman developed left calf pain and weakness, but this quickly generalised to paraplegia. We diagnosed acute myelitis based on the results of clinical manifestations, an MRI examination and a cerebrospinal fluid (CSF) examination. The clinical condition and spinal cord lesions improved following intravenous administration of methylprednisolone. The patient had been diagnosed with HCV infection 11 years before the onset. We detected HCV RNA in the CSF, supporting the strong association of our patient's myelitis. However, it is difficult to conclude whether the neurological condition was caused directly by the viral load or indirectly by the immune response. We suggest that testing for HCV infection is important in patients with myelitis. In particular, anti-HCV antibody and HCV RNA should be measured in the patients' serum as well as CSF.Case Reports 06/2013; 2013. DOI:10.1136/bcr-2013-008934