Neurológia pre prax 3/2013

Peripheral neuropathy and hepatitis C

Infection with the hepatitis C virus (HCV) can be associated with extrahepatic manifestations in as much as 36% of HCV patients, mainly with cryoglobulinemia, thrombopenic purpura, and membranoproliferative glomerulonephritis. The mixed cryoglobulinemia is characterized by a typical clinical triad (purpura, weakness, arthralgias) and by involvement of one or more organs or systems (liver, kidney, and peripheral nerve). Peripheral neuropathy may also be associated with HCV infection and it is usually related to mixed cryoglobulinaemia but neuropathies in the absence of serum cryoglobulins have also been described. HCV-associated neuropathy is usually an axonal-type chronic symmetrical sensory or sensorimotor polyneuropathy or a subacute mononeuropathy multiplex due to vasculitis. Treatment with pegylated interferon-alfa and ribavirin mostly is associated with an improvement of hepatic parameters and vasculitic symptoms. In some cases, worsening or even new onset of peripheral neuropathy was observed. These patients can improve with rituximab that represent an alternative treatment.

Keywords: hepatitis C, extrahepatic manifestations, cryoglobulinemia, peripheral neuropathy.