Peripheral neuropathy without cryoglobulinemia in patients with hepatitis C virus infection

Background. An association between essential mixed cryoglobulinemia and hep atitis C virus infection has been documented by many reports. Some clinical manifestations such as purpura, arthralgia, vascular lesions and periphera l neuropathies are also connected with the presence of detectable cryoglobu lins. The association between HCV infection, the presence of mixed cryo-glo bulinemia and peripheral neuropathy is well documented. The aim of this stu dy was: to define the possible presence of peripheral neuropathy in HCV pat ients without detectable cryoglobulins and the! possible association with t he different genotypes. Methods. Twenty patients (11 females, 9 males) with chronic HCV hepatitis a nd without detectable cryoglobulins were submitted to neurological and elec trophysiological studies to detect a possible peripheral neurological invol vement. In all patients the HCV infection was assumed by the presence of an tibodies to HCV with EI,ISA assay acid then confirmed with recombinant immu noblot assay. HCV genotyping was obtained by INNO LIPA in 15 out of 20 pati ents. In 4 patients a sural nerve biopsy was possible. Results, Genotype 1b was present in 80 % of patients, while la in 13.3 % an d 4 in 6.695. Thirteen patients had positive neurological anamnesis (65%), while neurological examination was positive in 40 % of the cases, Electromy ographic study was positive in 50 % of subjects, The sural nerve biopsies a greed with axonal degeneration in amyelinated Fibres, Conclusions. Our results suggest a possible peripheral neurological system involvement in patients with HCV infection without cryoglobulins.