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Panminerva Medica 2000 September;42(3):175-8

lingua: Inglese

Peripheral neuropathy without cryoglobulinemia in patients with hepatitis C virus infection

Paoletti V., Donnarumma L., De Matteis A., Mammarella A., Labbadia G., Musca A., Francia A. *

From the Department of Medical Therapy
*Department of Neurological Sciences University “La Sapienza”, Rome, Italy


Background. An asso­ci­a­tion ­between essen­tial ­mixed cryo­glo­bu­li­ne­mia and hep­a­titis C ­virus infec­tion has ­been doc­u­ment­ed by ­many ­reports. Some clin­i­cal man­i­fes­ta­tions ­such as pur­pu­ra, arthral­gia, vas­cu­lar ­lesions and periph­er­al neu­rop­a­thies are ­also con­nect­ed ­with the pres­ence of detect­able cryo­glob­u­lins. The asso­ci­a­tion ­between HCV infec­tion, the pres­ence of ­mixed cryo­glo­bu­li­ne­mia and periph­er­al neu­rop­a­thy is ­well doc­u­ment­ed. The aim of ­this ­study was to ­define the pos­sible pres­ence of periph­er­al neu­rop­a­thy in HCV ­patients with­out detect­able cryo­glob­u­lins and the pos­sible asso­ci­a­tion ­with the dif­fer­ent gen­o­types.
Methods. Twenty ­patients (11 ­females, 9 ­males) ­with chron­ic HCV hep­a­titis and with­out detect­able cryo­glob­u­lins ­were sub­mit­ted to neu­ro­log­i­cal and elec­tro­phys­io­log­i­cal stud­ies to ­detect a pos­sible periph­er­al neu­ro­log­i­cal involve­ment. In all ­patients the HCV infec­tion was ­assumed by the pres­ence of anti­bod­ies to HCV ­with ­ELISA ­assay and ­then con­firmed ­with recom­bi­nant immu­no­blot ­assay. HCV gen­o­typ­ing was ­obtained by ­INNO ­LIPA in 15 out of 20 ­patients. In 4 ­patients a ­sural ­nerve biop­sy was pos­sible.
Results. Genotype 1b was ­present in 80% of ­patients, ­while 1a in 13.3% and 4 in 6.6%. Thirteen ­patients had pos­i­tive neu­ro­log­i­cal anam­ne­sis (65%), ­while neu­ro­log­i­cal exam­ina­tion was pos­i­tive in 40% of the cas­es. Electromyographic ­study was pos­i­tive in 50% of sub­jects. The ­sural ­nerve biop­sies ­agreed ­with axo­nal degen­er­a­tion in amyel­i­nat­ed ­fibres.
Conclusions. Our ­results sug­gest a pos­sible periph­er­al neu­ro­log­i­cal ­system invol­vement in ­patients ­with HCV infec­tion with­out cryo­glob­u­lins.

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