Necrotizing myopathy in a patient with chronic hepatitis C virus infection: a case peport and a review of the literature

We describe a 61-year-old man presenting with necrotizing myopathy associat ed with chronic active hepatitis due to hepatitis C virus (HCV) infection. Thirteen patients with HCV-associated myopathy have been reported previousl y. In most of these cases, varying degrees of inflammatory changes were obs erved in the muscle tissue. In 2 patients, myopathy developed after initiat ion of interferon therapy for chronic HCV hepatitis. Our case was unusual d ue to long-standing elevation of creatine kinase values which improved foll owing interferon therapy and the non-inflammatory features of the muscle ti ssue where the HCV RNA minus strand, a marker for replicative intermediates of the virus, was undetectable. The association of myopathy with HCV infec tion might represent a unique clinical entity, although the underlying path ological mechanisms remain unknown.