To determine the incidence of hepatitis C virus (HCV) infection in patients with alcoholic liver disease (ALD), serum samples from 252 patients with ALD were tested for anti-HCV and HCV RNA. Serial sera of these patients were collected and stored under optimal conditions to allow exact quantification of HCV RNA. Fifteen patients who visited our hospital during the same period of time with chronic HCV infections served as controls. In those with ALD, anti-HCV and HCV RNA were positive in 55.5% and 41.2%, respectively. Patients with histologically diagnosed chronic hepatitis and hepatocellular carcinoma had much higher prevalence rates of HCV RNA (84% and 100%, respectively) compared to those with fatty liver (4.3%), hepatic fibrosis (10.1%) and alcoholic hepatitis (22.2%) (P < 0.01). Although no difference in serum HCV RNA levels was observed between the patients with both ALD and chronic HCV infection and those with chronic HCV infection alone, HCV RNA levels significantly (10-fold) dropped after abstinence in nearly half of the patients (P < 0.01). These data indicate that HCV infection in patients with ALD promotes progression of liver disease, and abstinence from alcohol is associated with a reduction in serum HCV RNA levels.

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Bilateral symmetric claustrum lesions shown on MR imaging are rarely reported, especially transient and reversible lesions associated with seizures, such as herpes simplex encephalitis, 1 unidentified encephalopathy, 2 and acute encephalitis with refractory repetitive partial seizures. 3 To our knowledge, there are no reports of symmetric bilateral claustrum lesions with mumps encephalitis. A 21-year-old man had been experiencing coldlike symptoms with headache and fever for a week when he vomited and had a tonicclonic seizure and was subsequently taken to a nearby emergency hospital (day 1). He had been noticing spasms on the left side of his face for 2 days. On his last visit to the hospital, he reported disorientation accompanied by fever; however, a brain MR imaging and CSF analysis showed no abnormalities. Because he was in status epilepticus on hospitalization, midazolam was administered by intravenous infusion at 3.0 mg/h. Around this time, the patient started to experience visual hallucinations and reported seeing cats and people who were not present, as well as auditory hallucinations: clicking sounds and strange voices. Brain MR imaging on day 6 indicated symmetric high-intensity lesions in the bilateral claustrum (Fig 1). CSF showed pleocytosis (59/L, lymphocytes 36/L, Polymorphonuclear leukocytes 23/L) with normal protein (27 mg/dL) and sugar levels (71 mg/ dL), suggesting viral encephalitis, thus the administration of acyclovir, 1500 mg/day, was started. On day 14, he was transferred to our hospital. On arrival, he was in a confused state with high fever and neck stiffness. There was no parotitis. Visual and auditory hallucinations were observed. There was no abnormality in the cerebral nerves except for a tongue tremor of 5ϳ6 Hz. No pyramidal, extrapyramidal, or cerebellar symptoms or signs were observed. A blood test showed no abnormalities, with negative indication of various autoantibodies, including glutamic acid decarboxylase, anti-nuclear antibody, anti-phospholipid antibody, Ro antibody, and La antibody. Screening for influenza A and B antigens from nasal mucosa, twice for several days, was negative for both. Laboratory studies were negative for herpes simplex virus, varicellazoster virus, cytomegalovirus, and human herpes virus 6 polymerase chain reaction (PCR) antibodies, but mumps virus PCR was positive, from which mumps encephalitis was diagnosed. Following the observation of a secondary generalization of seizures starting from the left leg, we maintained midazolam. However, an electroencephalogram revealed a slow basic rhythm with epileptic discharge. Visual and auditory hallucinations as well as tongue tremor persisted. When we administered risperidone (1 mg/day), the visual and auditory hallucinations and tongue tremor gradually improved and disappeared by day 21. A brain MR imaging on day 19 showed no lesions in the bilateral claustrum (Fig 1). By day 65, the seizures could be controlled by oral administration of an anticonvulsant (sodium valproate at 900 mg/day and phenytoin at 250 m...

Interferon (IFN) is widely used for patients with hepatitis C. Less than half of treated patients respond to IFN therapy, however, and increased resistance to IFN is particularly observed in genotype 1b patients. Recently, genotype 1b patients with the wild type sequence in the NS5A gene were shown to be resistant to therapy, suggesting that the NS5A protein may be involved to IFN resistance. Thus, we investigated the serum 2',5'-oligoadenylate synthetase (2',5'-OAS) levels before and during IFN treatment. In addition, other biochemical markers and NS5A mutations were also examined in 30 HCV genotype 1b-positive patients. Before IFN treatment, 2',5'-OAS activity in sera was significantly lower in wild type patients than in mutant type patients. All patients were subsequently enrolled in IFN therapy, and 2',5'-OAS activity was elevated both in wild and mutant type patients, irrespective of the number of mutations in NS5A. Logistic regression analysis revealed that clearance of serum HCV RNA was independently related to the pretreatment viral load and NS5A mutations, but not to serum 2',5'-OAS activity. We concluded that the NS5A protein, that is associated with the outcome of IFN therapy, affects the kinetics of IFN-induced molecules, such as 2', 5'-OAS. 2',5'-OAS activity does not, however, seem to be related to long-term virological response to IFN therapy.

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