Neuropatia periférica associada à crioglobulinemia em paciente com hepatite C: relato de caso e revisão da literatura

Abstract

BACKGROUND AND OBJECTIVES:Hepatitis C is an infectious disease affecting approximately 170 million people worldwide. In addition to the liver disease, the virus causes extra-liver manifestations, such as peripheral neuropathy and essential mixed cryoglobulinemia. This study aimed at presenting a case of a patient with hepatitis C virus who developed cryoglobulinemia associated to peripheral neuropathy. CASE REPORT: Male patient, 62 years old, with hepatitis C subtype 1 diagnosed more than 10 years ago, with possible contamination after right knee surgical procedure. He presented initially "shock"-type pain episodes followed by hands and feet continuous paresthesia in boot-glove pattern, associated to Raynaud phenomenon and lower limbs petechiae. He evolved along the years with motor deficit in left fibular nerve leading to foot-drop. Plasma cryoglobulines test was positive. Pain became continuous, severe, symmetric, located in the distal third and lateral face of lower limbs. When the evaluation of the multidisciplinary pain and rehabilitation team was asked, tramadol (50 mg) every 6 hours and gabapentin (900 mg/day) were prescribed in association to pulse therapy with total resolution of pain in some weeks. Orthosis and daily rehabilitation were needed for several months. CONCLUSION: As early as possible, multimodal treatment with different classes of drugs associated to adequate rehabilitation is directly associated to a better prognosis for this type of neuropathy.