Peripheral neuropathy and chronic hepatitis C virus: a frequent association?

Objective. - The aim of this prospective study was to evaluate the prevalen ce of rite peripheral neuropathies associated with chronic hepatitis C and their clinical, electrophysiological and histological characteristics. Patients and methods. - Thirty six patients admitted from December 1994 to January 1996 for chronic hepatitis C were prospectively investigated. Labor atory data included liver blood rests, serum cryoprecipitate immunoelectrop horesis, assays for anti-nuclear antibody, rheumatoid factor, circulating i mmune complexes, anti-SSA and anti-SSB antibodies. For each patient, a clin ical neurological evaluation as well as an electrophysiological evaluation were performed by the same operator. In presence of peripheral neuropathy, a neuromuscular biopsy was performed. Results. - In seven patients (19%), a peripheral neuropathy was diagnosed r elated to hepatitis C virus in 3 patients. In these 3 patients presenting w ith leg paresthesia, an axonal sensitive neuropathy was evidenced by electr omyography. A neuromuscular biopsy performed in two of these patients showe d a severe diminution of the myelinated fibers associated with vasculitis l esions in one patient. A skin biopsy was performed in the third patient wit h leg purpura revealing a leukocytoclasic vasculitis. A positive cryoglobul inemia was Sound in two of these patients. Conclusion. - In chronic hepatitis C, the prevalence of peripheral neuropat hy is 8% and usually associated with cryoglobulinemia. It is an axonal neur opathy with diminution of the myelinated fibers and vasculitis lesions in t he absence of cryoglobulinemia.