Creighton University Medical Center Omaha, NE, United States
Amarjyot K. Randhawa, MBBS1, Yazan Addasi, MD1, Meghana Khedekar, MBBS1, Yu-Ting Chen, MD2, Manasa Velagapudi, MBBS1 1Creighton University Medical Center, Omaha, NE; 2Creighton University, Omaha, NE
Introduction: Peripheral neuropathy in hepatitis C manifests as pure-sensory axonopathy, mononeuritis multiplex, or distal sensory or motor polyneuropathy. We here present a case of mononeuritis multiplex in a patient with hepatitis C.
Case Description/Methods: A 53-year-old African American man with untreated chronic hepatitis C diagnosed 29 years ago, presented with bilateral hand weakness, numbness and pain. It came on gradually over a period of 10 days and then stabilized. He was diagnosed with peripheral neuropathy diagnosed 8 years ago. He was a 15-pack year smoker and denied alcohol use. On examination he had bilateral ulnar intrinsic muscle weakness worse on the left side, median nerve innervated muscle weakness on the right, sensory loss to pinprick in bilateral ulnar nerve distribution. Reduced pinprick sensation, thermal pain and deep tendon reflexes in bilateral lower extremity were elicited. EMG studies were suggestive of bilateral ulnar and right median neuropathy with overall picture of mixed fiber polyneuropathy. HemoglbinA1c was 4.5, normal vitamin B12 and TSH level. Polyneuropathy panel, Sjogren’s syndrome work up, ANCA antibodies, complement results were all normal. Hepatitis C viral load for genotype 1a was 39000, Syphilis and HIV screen were negative. Serum cryoglobulins resulted positive. Based on the presentation he was diagnosed with polyneuropathy secondary to Hepatitis C induced mixed cryoglobulinemia. He was started on gabapentin and was referred to Infectious Diseases clinic. He was treated with 12 weeks of sofosbuvir/velpatasvir and steroids. Repeat EMG showed improved bilateral median distal motor latencies, R median conduction velocity, R ulnar CMAP and R ulnar conduction velocity. Repeat cryoglobulin was trace and symptoms resolved as well.
Discussion: In patients with long-standing HCV infection presenting with neuropathic symptoms, thorough evaluation using EMG and serum cryoglobulin levels for polyneuropathy, mononeuritis multiplex or multiple mononeuropathy should be considered. Presence of serum cryoglobulin is a negative prognostic marker for severity of neuropathy in HCV patients. Duration of HCV infection has a strongly correlates with HCV polyneuropathy. Early treatment may prevent further progression of symptoms. Mild to moderate neuropathy responds to steroid and/or interferon therapy. Those who do not respond, antiviral therapy or intravenous immunoglobulins should be considered.
Disclosures: Amarjyot Randhawa indicated no relevant financial relationships. Yazan Addasi indicated no relevant financial relationships. Meghana Khedekar indicated no relevant financial relationships. Yu-Ting Chen indicated no relevant financial relationships. Manasa Velagapudi indicated no relevant financial relationships.
Amarjyot K. Randhawa, MBBS1, Yazan Addasi, MD1, Meghana Khedekar, MBBS1, Yu-Ting Chen, MD2, Manasa Velagapudi, MBBS1. P0779 - An Unnerving Side of Hepatitis C, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.