Transverse myelitis associated to HCV infection

Abstract

Complications involving the central nervous system in patients suffering from hepatitis C virus (HCV) infection have been rare. Among them, it appears the transverse myelitis, which has already been reported in likely association with HCV. This paper presents the case study of a 65-year-old woman who developed cervical transverse myelitis linked to chronic HCV infection and anti-HCV antibodies in the spinal fluid, being excluded other etiologies for transverse myelitis. Current evidence has reinforced the likely association between chronic HCV infection and transverse myelitis, especially as recurrent manifestations of the disease. These findings reveal the need for more searching to establish the causal relationship between transverse myelitis and hepatitis C. Key-Words: Central Nervous System, HCV infection, transverse myelitis. The World Health Organization estimates that infection by the hepatitis C virus (HCV) affects around 3% of the world population [1], being one of the main causes of the chronic hepatic disease. In HCV-positive patients, extra-hepatic symptoms are reported in up to 74% of the cases, 10% to 15% of which regarding the neurological changes, mainly in the peripheral nervous system, and in this context associated to the cryoglobulinaemia. Manifestations observed in the central nervous system (CNS) include chronic forms of encephalopathy, epilepsy, normal pressure hydrocephaly, ischemic encephalovascular syndrome, Ekbom syndrome, and encephalomyelitis [2][3][4][5].Transverse myelitis (TM) is a demyelinating disease of the spinal cord. The disease is characterized by the emergence of acute or sub acute signs and symptoms of motor, neurological, and autonomic dysfunction related to the nervous tracts of the spinal cord [6]. TM often occurs due to inflammatory and infectious processes, rheumatologic, neoplastic, iatrogenic, demyelinating, compressive, actinic as well as idioapthic diseases [7,8]. TM associated to HCV infection has recently been reported, and although the causal mechanism has not been fully established yet, it is hypothesized that the virus may act directly in the development of TM, or lead to immune-mediated injury.This paper is a case study of a patient who suffered from cervico-dorsal spinal cord myelitis, In association with updated literature, this study case adds evidence about the association between HCV and TM. Case ReportThe patient was a nulliparous, non-smoker 65-year-old caucasian woman previously alcoholic but abstemious for eight years, with obesity degree 3, hypertension, diabetes mellitus type II, and with a metallic mitral valve for nine months. The patient was from the central region of the state of Rio Grande do Sul, Brazil, and had been taking warfarin, metphormin, glibenclamide, hydrochlothiazide, metoprolol, enalipril, and furosemide at the time of hospital admission.On admission, complaints reported by the patient included strong and progressive thoracolumbar pain for 30 days, which evolved with the loss of strength and sensitivity in lower limbs five days ...

A Case of Acute Disseminated Encephalomyelitis Associated with Hepatitis C Virus Infection

“…In a case of acute transverse myelitis associated with chronic HCV infection, anti-HCV antibody was present in the CSF. 10 In our case, anti-HCV antibody was also detected in the CSF. It is hypothesized that the virus might have penetrated blood brain barrier and involved the CNS directly.…”

Acute disseminated encephalomyelitis associated with hepatitis B virus reinfection – Consequence or coincidence?

“…ADEM associated with HCV has been reported before [9], and recently Sim et al report a case of ADEM associated with hepatitis C virus (HCV) infection with positive serum and cerebrospinal fluid (CSF) anti-HCV antibody [15]. In a case of acute transverse myelitis associated with chronic HCV infection, anti-HCV antibody was present in the CSF [16]. It is hypothesized that the virus might have penetrated blood brain barrier and involved the CNS directly.…”

Retención de orina en un paciente inmunocompetente: mielitis transversa aguda

“…Otros procesos causantes son los de origen infeccioso, que provocan una agresión directa en la médula espinal. Son muchos los microorganismos sobre los que existen casos publicados: dengue, parotiditis, sarampión, rubeóla, virus Hepatitis C, B y E, CMV, VEB, VVZ, Coxackie, Influenza, VHS, micobacterias, Mycoplasma pneumoniae, sífilis, Listeria o Borrelia 9,10 . En un número no desdeñable de ocasiones resulta complejo discernir su patogenia ya que los cuadros infecciosos o incluso las vacunaciones (difteria, tétanos, rubéola, hepatitis B, rabia, Bordetella pertussis, cólera, tifus, poliomielitis) pueden ocasionar una brusca reacción inmune que es la que finalmente produce la necrosis de la sustancia gris o la lesión de la sustancia blanca, con desmielinización perivenosa e infiltrados linfocitarios 11 .…”