Hepatitis C virus infection and myositis: a polymerase chain reaction study

Abstract

Muscle biopsy tissue from a patient with chronic hepatitis, who was hepatitis C virus (HCV) positive and showed slight weakness of the right arm and leg associated with increased serum creatine kinase levels, was studied using immunocytochemical and polymerase chain reaction (PCR) techniques. Muscle biopsy showed changes compatible with an inflammatory myopathy. Immunohistochemical studies included the use of monoclonal antibodies against human T lymphocytes, macrophages, immunoglobulins, major histocompatibility complex class I molecules (MHC-I), and the neoantigens of the terminal C5b-9 complement membrane attack complex (MAC). In addition to confirming the potential importance of cytotoxic T cells and MHC-I antigen expression in inducing muscle pathology, we demonstrated MAC deposition and the presence of HCV-RNA in the muscle of our patient, suggesting that direct involvement of the virus leading to complement activation might be important in inducing muscle damage.

Hepatitis C virus does not infect muscle, the intervertebral disk, or the meniscus in patients with chronic hepatitis C

“…The presence of HCV RNA in muscle tissue from patients with chronic hepatitis C and myositis has been reported previously [Villanova et al, 2000;Di Muzio et al, 2003;Ho et al, 2005]. In contrast, in the present study, viral RNA was not detected in the two muscle biopsies examined.…”

“…These disorders may be the consequence of an autoimmune phenomenon induced by HCV or may be caused by the infection of the cells of the muscle-skeletal system by the virus. In this context, HCV RNA has been detected in muscle from patients with chronic HCV infection and mysositis but in situ hybridization studies have provided contradictory results on the cell types infected by the virus [Villanova et al, 2000;Di Muzio et al, 2003;Ho et al, 2005]. Furthermore, whether HCV is capable of infecting other tissues of the muscleskeletal system, such as the meniscus or the intervertebral disk, has not been studied.…”

“…Several studies have shown that HCV may infect tissues other than the liver [Muller et al, 1993;Arrieta et al, 2000;Rodriguez-Iñ igo et al, 2000;Yan et al, 2000;Lá zaro et al, 2002;Radkowski et al, 2002]. With respect to the musculoskeletal system, HCV RNA has been detected by reverse transcription-polymerase chain reaction (RT-PCR) in a muscle biopsy from a patient with myositis and chronic HCV infection [Villanova et al, 2000]. However, RT-PCR does not provide information about the localization of the viral RNA within the tissue.…”

West Nile virus encephalitis with myositis and orchitis

“…In that the inflammatory response is selectively composed of cytotoxic T-lymphocytes, it closely resembles hepatitis C virus myositis, also a flavivirus. 9 The association of WNV myositis with encephalitis that affects predominantly motor neurons raises the question if the virus gains entry into the CNS via peripheral nerves analogous to rabies viral infections that are known to spread along peripheral nerves to the CNS. Similarly, intra-axonal bacterial spread was recently shown to cause Listeria rhombencephalitis and myelitis when applied intramuscularly.…”

Acute Hepatitis E with Elevated Creatine Phosphokinase

“…In contrast, to our knowledge there have been no reports of acute hepatitis E accompanied by myositis or muscle dysfunction. Regarding the occurrence of myositis or muscle dysfunction in other viral hepatitis infections, a few cases of HAV, HBVor HCV infection with elevation of CKhave been reported in the literature (12)(13)(14). All 12 patients with acute hepatitis A, B, or C whowere admitted to our department over a ten-year period showed the normal range of CK.…”